Basal Insulin and Cardiovascular and Other Outcomes in Dysglycemia

In this study with a 2-by-2 factorial design, patients with cardiovascular risk factors and dysglycemia or type 2 diabetes received insulin glargine or standard care. Insulin treatment did not affect cardiovascular events, the primary outcome. An elevated fasting plasma glucose level is an independent risk factor for adverse cardiovascular outcomes. 1 – 7 Basal insulin secretion is required to maintain fasting plasma glucose levels below 100 mg per deciliter (5.6 mmol per liter), and an elevated fasting plasma glucose level indicates that there is insufficient endogenous insulin secretion to overcome underlying insulin resistance. 8 , 9 The correction of this deficiency may reduce cardiovascular outcomes. Such a possibility has not been formally tested; however, large outcomes trials of more versus less intense glucose lowering in which insulin was used in both study groups have not shown a clear cardiovascular . . .