Editing Intensive insulin therapy (section)

==Advantages and disadvantages==
The two primary advantages of intensive/flexible therapy over more traditional two or three injection regimens are:
# greater flexibility of meal times, carbohydrate quantities, and physical activities, and
# better glycemic control to reduce the incidence and severity of the complications of diabetes.

Major disadvantages of intensive/flexible therapy are that it requires greater amounts of education and effort to achieve the goals, and it increases the daily cost for glucose monitoring four or more times a day.  This cost can substantially increase when the therapy is implemented with an insulin pump and/or continuous glucose monitor.

It is a common notion that more frequent hypoglycemia is a disadvantage of intensive/flexible regimens.<ref>{{cite journal | vauthors = Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, Rand L, Siebert C | display-authors = 6 | title = The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus | journal = The New England Journal of Medicine | volume = 329 | issue = 14 | pages = 977–986 | date = September 1993 | pmid = 8366922 | doi = 10.1056/NEJM199309303291401 | s2cid = 21528496 | doi-access = free }}</ref> The frequency of hypoglycemia increases with increasing effort to achieve normal blood glucoses with most insulin regimens, but hypoglycemia can be minimized with appropriate glucose targets and control strategies. The difficulties lie in remembering to test, estimating meal size, taking the meal bolus and eating within the prescribed time, and being aware of snacks and meals that are not the expected size. When implemented correctly, flexible regimens offer greater ability to achieve good glycemic control with easier accommodation to variations of eating and physical activity.

A 2020 [[Cochrane (organisation)|Cochrane]] [[systematic review]] did not find enough evidence of reduction of cardiovascular mortality, non-fatal [[myocardial infarction]] or non-fatal [[stroke]] when comparing insulin to metformin monotherapy.<ref>{{cite journal | vauthors = Gnesin F, Thuesen AC, Kähler LK, Madsbad S, Hemmingsen B | title = Metformin monotherapy for adults with type 2 diabetes mellitus | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | issue = 6 | pages = CD012906 | date = June 2020 | pmid = 32501595 | pmc = 7386876 | doi = 10.1002/14651858.CD012906.pub2 | editor-last = Cochrane Metabolic and Endocrine Disorders Group }}</ref>