Management of Type 2 Diabetes - The Role of Basal Insulin
Management of Type 2 Diabetes - The Role of Basal Insulin
European Endocrine Disease 2007 - Issue I
Published: October 2008
Published: October 2008
Type 2 diabetes and its complications are affecting increasing numbers of people worldwide. The burden of serious complications can be considerable for the individual and for the healthcare system. Many of these complications can be prevented or their progression halted with good early management of the condition, including effective management of blood glucose levels. In addition, people with poorly controlled diabetes are at higher risk of cardiovascular disease events, which are a major cause of morbidity and mortality.
Large-scale clinical trials have demonstrated the benefits of tight control in type 2 diabetes, minimising disease complications and improving quality of life.1,2 Recognising the progressive nature of type 2 diabetes, treatment programmes incorporating the use of insulin earlier in its course are receiving increasing attention. The United Kingdom Prospective Diabetes Study (UKPDS) Group followed nearly 3,900 patients with type 2 diabetes receiving intensive therapy with a sulphonylurea or insulin over 10 years and compared these patients with a control group receiving conventional treatment (dietary therapy alone). The patients who received intensive therapy had a 25% risk reduction in microvascular end-points compared with those who received conventional therapy.
During the past several years, developments of several new oral antidiabetic agents and insulin preparations have expanded therapeutic choices for glycaemic control, more effectively enabling patients to reach and maintain blood glucose targets.3 These developments also allow for a choice of effective combinations of therapeutic agents to meet goals. Insulin remains an important treatment option among these. The purpose of this article is to highlight how insulin can be used effectively in clinical practice in order to get patients to recommended goals.
Insulin – Still a Treatment Option
Type 2 diabetes is characterised by decreased sensitivity of body tissues to insulin. However, even in insulin-resistant subjects, type 2 diabetes develops only when there is a relative deficiency of insulin secretion from the pancreas. This pancreatic defect progresses despite therapy and, over time, most patients have very little residual insulin secretion and require exogenous insulin replacement. In addition, it is recognised that about 10% of people with apparent type 2 diabetes have evidence of autoimmune disease that is associated with earlier loss of beta-cell function than in classic type 2 diabetes.4 Thus, over time, insulin therapy becomes important for most patients with type 2 diabetes.
References:
- Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34), UK Prospective Diabetes Study (UKPDS) Group, Lancet, 1998;352:854–65.
- Nathan DM, Cleary PA, Backlund JY, et al., Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes, N Engl J Med, 2005;353:2643–53.
- Nathan DM, Buse JB, Davidson MB, et al., Management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes, Diabetes Care, 2006;29:1963–72.
- Palmer JP, Hampe CS, Chiu H, et al., Is latent autoimmune diabetes in adults distinct from type 1 diabetes or just type 1 diabetes at an older age?, Diabetes. 2005;54 Suppl 2:S62–7.
- Turner RC, Cull CA, Frighi V, Holman RR, Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49), UK Prospective Diabetes Study (UKPDS) Group, JAMA, 1999;281:2005–12.
- Kahn SE, Haffner SM, Heise MA, Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy, N Engl J Med, 2006;355:2427–43. 7. http://clinicaltrials.gov/ct/gui/show/NCT00069784
- Riddle MC, Rosenstock J, Gerich J, The Treat-to-Target Trial: randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients, Diabetes Care, 2003;26:3080–6.
- Meneghini LF, Rosenberg KH, Koenen C, et al., Insulin detemir improves glycaemic control with less hypoglycaemia and no weight gain in patients with type 2 diabetes who were insulin naive or treated with NPH or insulin glargine: clinical practice experience from a German subgroup of the PREDICTIVE study, Diabetes Obes Metab, 2007;9:418–27.
- Davies M, Storms F, Shutler S, et al., Improvement of glycemic control in subjects with poorly controlled type 2 diabetes: comparison of two treatment algorithms using insulin glargine, Diabetes Care, 2005;28:1282–8.
- Rosenstock J, Basal insulin supplementation in type 2 diabetes; refining the tactics, Am J Med, 2004;116(Suppl.3A):10S–16S.
