PMID: 11910979Mar 26, 2002Paper

Insulin treatment in type 2 diabetes: epidemiological data

Diabetes & Metabolism
L Papoz

Abstract

After several years of disease duration, blood glucose control is difficult without using insulin in type 2 diabetic patients. However, large differences are observed regarding the use of insulin from the south to the north of Europe. A positive effect of insulin therapy on metabolic control compared to oral antidiabetic agents is shown only in clinical trials performed on selected patients. As to degenerative complications, a great excess of retinopathy is observed in insulin-treated patients in several surveys, without possibility to determine the specific effect of treatment from that of disease severity. The UKPDS is the only randomised long-term clinical trial with a large number of patients. The aim was to compare conventional to intensive antidiabetic treatment, whatever the type or drug, insulin or sulfonyureas. After a ten-year follow-up, glycemic control was better with the intensive treatment, the microvascular complications less frequent by 25%, but the benefit on cardiovascular complications or mortality was modest. Another clinical trial from US shows that a too strict insulin regimen could perhaps have no effect or even opposite to the objectives regarding cardiovascular morbidity. Considering these clinical unce...Continue Reading

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