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These patients had poor blood sugar control even though they were taking two common oral diabetes medications, metformin and sulfonylurea, the researchers noted.

Three years into the trial, the researchers found that slightly more than 43 percent of the patients taking basal insulin and about 45 percent of the patients taking insulin at mealtime achieved good blood sugar control, compared with about 32 percent of those taking biphasic insulin.

In addition, those on basal insulin had a lower incidence of low blood sugar, a serious side effect of insulin therapy, compared to those on biphasic or mealtime insulin, Holman's team found. Moreover, patients on basal insulin gained less weight than people on the other two regimens.

"These findings provide clear evidence for people with type 2 that supports starting insulin therapy with a once-a-day basal insulin and subsequently adding a mealtime insulin if glycemic targets are not met," Holman said.

Dr. Michael Roden, from the Institute for Clinical Diabetology at the German Diabetes Center at Heinrich Heine University Clinics in Dusseldorf, and author of an accompanying journal editorial, said that "you need to do a lot to control blood glucose in type 2 diabetic patients when they need insulin."

Roden noted that while basal insulin is the place to start insulin therapy in type 2 diabetes, over time, mealtime insulin will need to be added to maintain blood sugar control.

Whether lowering blood sugar with insulin and other medications will prevent complications from diabetes, this study was too short to tell, Roden said. "The study was not powered to analyze the so-called hard endpoints, such as eye complications or, most importantly, cardiovascular problems," he said.