[Insulin treatment in type 2 diabetes: epidemiological data].
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 uncertainties and the need for more definite long-term clinical data, it is justified to conduct additional long-term clinical studies in this field. Furthermore after secondary failure of oral anti-diabetic agents in type 2 diabetic patients, it appears reasonable to discuss the rational for insulin treatment based on an individual assessment, particularly in older diabetics, weighing the whole benefits and risks for a given patient of such an important therapeutic change.
Papoz
L
L
INSERM U500, Epidémiologie des Maladies Chroniques et du Vieillissement, 39 av Charles Flahault, 34093 Montpellier. papoz@u500.montp.inserm.fr
D000284:Administration, Oral; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use*; D015995:Prevalence
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin