Article

Early insulin: an important therapeutic strategy.

Diabetes Care (Impact Factor: 8.57). 02/2005; 28(1):220-1. DOI: 10.2337/diacare.28.1.220
Source: PubMed
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    ABSTRACT: There are a variety of oral hypoglycemic agents available for use in type 2 diabetes. Despite the increasing choices of oral agents, insulin therapy remains the most effective means to lower blood glucose and often must be used. There is some controversy as to the best approach to the initiation of insulin treatment in type 2 diabetes. The approach we favor begins with basal insulin with later addition of premeal rapid-acting insulin. Drug Dev Res 69:116–118, 2008. © 2008 Wiley-Liss, Inc.
    Drug Development Research 05/2008; 69(3). · 0.87 Impact Factor
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    ABSTRACT: To investigate whether duration of diabetes has an impact on the effectiveness of insulinization in diabetes management. This open-label, noninterventional, observational registry was conducted at >500 centers in Korea. Patients with diabetes, on oral antidiabetic drugs, with HbA1c ≥7 % (53 mmol/mol) in the preceding 3 months, being considered for initiation of basal insulin by their physicians, were included. Data were collected at baseline and at 3 and 6 months. Of 6,616 patients evaluated, 62.5 % had diabetes for <10 years, while only 6.5 % patients had diabetes for ≥20 years. At the end of study, average HbA1c in patients with diabetes for <10 years, for 10 to <20 years, and for ≥20 years was 7.3 ± 1.0 % (56 ± 10.9 mmol/mol), 7.4 ± 1.0 % (57 ± 10.9 mmol/mol), and 7.6 ± 1.1 % (60 ± 12.0 mmol/mol), respectively. Over half the patients (50.7 %) with diabetes <10 years achieved HbA1c <7 % (53 mmol/mol) by the end of study, while only 42.1 and 35.1 % patients with diabetes for 10 to <20 and ≥20 years, respectively, achieved their target. The average insulin dosage required for per unit HbA1c reduction was significantly different among the groups according to duration of type 2 diabetes mellitus (p < 0.05). Among patients who achieved HbA1c <7 %, proportion of patients with hypoglycemia in the ≥20 years group was higher than that in the <10 years, 10 to <20 years groups. Early insulin administration provided a better glycemic control with less insulin dosage and lower frequency of hypoglycemic events. Thus, early insulinization might hold the key to better management of type 2 diabetes mellitus.
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