[ Diabetes Solutions ]

Optimal glycemic control in type 2 diabetic patients. Does including insulin treatment mean a better


OBJECTIVE The effect of additional treatment with oral hypoglycemic agents on the progression of atherosclerosis remains unknown in insulin-treated patients with type 2 diabetes mellitus (T2DM). In the UKPDS trial the intensive treatment of hyperglycaemia in newly detected patients with type 2 diabetes based on insulin or sulponylurea (no separation possible) revealed a significant reduction of myocardial infarction risk (15%, P=0.01), but only after prolonged post-study follow-up after 10 years1. In contrast, insulin is a hormone produced by the pancreas that allows the body to use glucose and prevents blood sugar levels from getting too high. Interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-α), and the soluble TNF-α receptors sTNFR-60 and sTNFR-80 were measured in serum samples taken from all patients. Study I was a double-blind randomized study where 175 patients with secondary failure to oral agents were started on insulin in addition to oral glibenclamide. GLP-1 also exerts complementary action with insulin and combinations of insulin with incretin-based treatments have been investigated as a pharmacological approach. This RCT is based on a comprehensive, critical review of the six largest RCTs that included insulin-naÏve T2DM patients [12–14, 16–18] and published summaries of the literature [19–22].

After Cox multivariate analysis, insulin-treated diabetes was found to be an independent predictor of mortality (hazard ratio 4.30, 95% CI 1.69-10.94) whereas non-insulin-treated diabetes was not (hazard ratio 0.95, 95% CI 0.31-2.93). -1.08 +/- 0.3 mmol/l, P = 0.02), and the required doses of insulin and other diabetic medications. The patients receiving glargine insulin during the 24-week study were also taking 3 or 4 mg of glimepiride and 850 mg or more of metformin. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Intervention allocation will be concealed for the principal investigator who is responsible for the data analyses. There is also a positive effect on hard end points such as microvascular disease in the eye, kidney, and nerves. In Japan, 22% of patients discontinued basal insulin in the year after initiation according to a reimbursement claim base [24].

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