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Insulin Sooner Than
Later For Reduced Risk of Complications
posted August 5, 2004
The availability of new insulin
analogues has expanded therapeutic options using an earlier transition from
monotherapy to combination therapy to minimize disease-associated morbidity.
The clinical progression of type 2 diabetes mellitus (DM) is well understood.
Glycemic control gradually deteriorates, and progression of DM eventually leads
to an increased risk for microvascular and macrovascular complications.
Reassessment of current insulin treatment strategies leading to restoration of
glycemic control is essential to prevent or stop the progression of type 2 DM
and its complications.
The purpose of this article was to review the importance of instituting a
strategy of basal insulin therapy in patients with type 2 DM. METHODS: Relevant
articles were obtained through an online search of PubMed and MEDLINE for
literature published from 1990 to 2003.
The results showed large-scale intervention trials, such as the United Kingdom
Prospective Diabetes Study (UKPDS), have reported that patients with type 2 DM
treated with oral combination therapy are unable to maintain glycemic control.
These observations have led to a reassessment of the role of insulin therapy in
type 2 DM. The importance of tight glycemic control through the aggressive use
of insulin early in the course of the disease is apparent from the UKPDS,
Diabetes Control and Complications Trial, and other, smaller studies.
Considerable evidence indicates that initiating a basal insulin-replacement
strategy with an existing oral regimen can result in regaining glycemic control.
Evidence emerging from recent studies indicates that use of intensive insulin
therapy early in the course of the disease may have a positive clinical impact
on outcome and slow the progression of complications. The availability of basal
insulin analogues has expanded treatment options and improved the efficacy of
therapeutic regimens for type 2 DM.
The available data suggest using an earlier transition from monotherapy to
combination therapy to minimize disease-associated morbidity. The availability
of new insulin analogues has expanded therapeutic options and offers the
potential to enhance the efficacy of therapeutic regimens for type 2 DM as well
as improve the ease and safety of treatment when A1c cannot be maintained <7% on
> or =1 oral antidiabetic agent.
Source: Diabetes In Control.com:
Clin Ther. 2004 Jun;26(6):889-901.
August 2004
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