ECE2013 Symposia New data treatment of hyperglycemia (3 abstracts)
Department of Clinical Sciences, Skåne University Hospital, Lund University, 205 02 Malmö, Sweden.
The evidence base for starting early insulin treatment in patients with type 2 diabetes is rather scanty. In the UKPDS trial the intensive treatment of hyperglycaemia in newly detected patients with type 2 diabetes based on insulin or sulponylurea (no separation possible) revealed a significant reduction of myocardial infarction risk (15%, P=0.01), but only after prolonged post-study follow-up after 10 years1. In 2012 the ORIGIN study was published showing no cardiovascular prevention in patients randomized to treatment with an insulin analogue (glargine) as compared to standard therapy2. Taken together these two studies do not fully support early insulin treatment in patients with type 2 diabetes for cardiovascular protection. However, other clinical considerations might be of importance, and according to the most recent recommendations from EASD/ADA and their treatment algorithm3 there may be clinical indications also to support early insulin treatment in these patients not controlled by metformin alone. It should be remembered that some patients with type 2 diabetes in need of very early insulin treatment may instead have late autoimmune diabetes in the adult (LADA) when a diagnosis based on antibodies should be made.
References: 1. Holman RR, Paul SK, Bethel MA, Matthews DR & Neil HA. 10-Year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008 359 15771589.
2. ORIGIN Trial Investigators, Gerstein HC, Bosch J, Dagenais GR, Díaz R, Jung H, Maggioni AP, et al. Basal insulin and cardiovascular and other outcomes in dysglycemia. N Engl J Med 2012 367 319328.
3. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, et al. Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2012 55 15771596.