Deinsulinisation in type 2 Diabetes: Evidence-based strategies for safe treatment simplification "Approaches to reducing insulin in type 2 diabetes".

Insulin remains a cornerstone in managing advanced type 2 diabetes (T2D), but long-term use poses challenges, including hypoglycemia, weight gain, and treatment burden. The advent of GLP-1 receptor agonists (GLP-1 RAs) and SGLT2 inhibitors (SGLT2i) has enabled the concept of deinsulinisation: reducing or withdrawing insulin in favor of safer, simpler therapies. This narrative review examines current evidence on deinsulinisation strategies, focusing on four key factors: age, HbA1c levels, BMI, and prior insulin regimen. Data from trials, observational studies, and guidelines suggest insulin withdrawal can be safe and effective, particularly in older adults, those with low daily insulin doses, and patients with stable glycemic control. Newer fixed-ratio combinations and once-weekly GLP-1 RAs support improved adherence, fewer hypoglycemic events, and weight loss. Predictors of success include lower insulin requirements, lower HbA1c levels, and shorter diabetes duration, though high-quality evidence is limited. Continuous glucose monitoring (CGM) and structured deprescribing protocols are key to minimizing clinical inertia and avoiding overtreatment. Deinsulinisation aligns with ADA/EASD guidance, especially for frail or elderly patients, emphasizing safety and quality of life. While individualized and closely monitored approaches are essential, deinsulinisation represents a paradigm shift toward more personalized, risk-balance, and patient-centered T2D care.