Insulin Therapy for Type 2 Diabetes

Insulin Therapy for Type 2 Diabetes Sanne G. Swinnen , MD , Joost B. Hoekstra , PHD and J. Hans DeVries , PHD From the Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands. Corresponding author: Sanne G. Swinnen, s.g.swinnen{at}amc.uva.nl . A number of landmark randomized clinical trials established that insulin therapy reduces microvascular complications ( 1 , 2 ). In addition, recent follow-up data from the U.K. Prospective Diabetes Study (UKPDS) suggest that early insulin treatment also lowers macrovascular risk in type 2 diabetes ( 3 ). Whereas there is consensus on the need for insulin, controversy exists on how to initiate and intensify insulin therapy. The options for the practical implementation of insulin therapy are many. In this presentation, we will give an overview of the evidence on the various insulin regimens commonly used to treat type 2 diabetes. Secondary analyses of the aforementioned landmark trials endeavored to establish a glycemic threshold value below which no complications would occur. The UKPDS found no evidence for such a threshold for A1C, but instead showed that better glycemic control was associated with reduced risks of complications over the whole glycemic range (“the lower the better”) ( 4 ). For the management of type 2 diabetes, this resulted in the recommendation to “maintain glycemic levels as close to the nondiabetic range as possible” ( 5 ). However, in contrast to the UKPDS, the Kumamoto study observed a threshold, with no exacerbation of microvascular complications in patients with type 2 diabetes whose A1C was