World Health Organization (WHO) has published guidelines on treatment intensification in type 2 diabetes and type of insulin in type 1 and type 2 diabetes in low-resource settings in the Annals of Internal Medicine online September 4, 2018. The guidelines include five key recommendations:

1. “Give a sulfonylurea to patients with type 2 diabetes who do not achieve glycemic control with metformin alone or who have contraindications to metformin

2. Introduce human insulin treatment to patients with type 2 diabetes who do not achieve glycemic control with metformin and/or a sulfonylurea

3. If insulin is unsuitable, a dipeptidyl peptidase-4 (DPP-4) inhibitor, a sodium–glucose cotransporter-2 (SGLT-2) inhibitor, or a thiazolidinedione (TZD) may be added.

4. Use human insulin in adults with type 1 diabetes and in adults with type 2 diabetes for whom insulin is indicated

5. Consider long-acting insulin analogues in adults with type 1 or type 2 diabetes, who have frequent severe hypoglycemia with human insulin.”