For a patient with type 2 diabetes who is not achieving glycemic control with oral agents, what is the recommended next step?

In the scenario of a patient with type 2 diabetes who is not achieving glycemic control with oral medications, the correct approach is to add long-acting insulin at bedtime. This method effectively allows for better management of blood glucose levels, particularly overnight and into the fasting state.

Long-acting insulin provides a consistent baseline level of insulin, helping to control blood sugar levels throughout the day and night. This can complement the body's natural insulin secretion and improve overall glycemic control. It is often an appropriate step when oral agents alone are insufficient, particularly in cases where the progression of the disease has led to decreased insulin sensitivity or secretion.

Using long-acting insulin offers the advantage of flexibility in dosing and can often be tailored to individual needs, leading to improved patient satisfaction and adherence to treatment. It can also mitigate the risk of significant nocturnal hypoglycemia, which might occur with the use of sliding scale insulin regimens or insulin pumps if not carefully managed.

Introducing sliding scale insulin could lead to more fluctuations in blood glucose levels rather than stable control over time. Increasing the dosage of oral medications may not address the underlying issues effectively and could increase the risk of side effects without providing the necessary glycemic control. Switching to an insulin pump is a more complex intervention that