How do you decide between adding oral orforglipron or starting prandial insulin in a patient with type 2 diabetes above goal on basal insulin?

This is a timely question in that it is clinically relevant, and in June 2026, the ACHIEVE-5 trial was published online in JAMA, which studied adding orforglipron to basal insulin.

If the patient is judged to be significantly insulinopenic--thin, low dose of basal insulin requirement, and high postpr...