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Insulin in the management of type 2 diabetes

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Abstract

Insulin is the most the effective available medication for treating hyperglycemia in type 2 diabetes. If used appropriately, it can decrease any level of elevated A1C to, or close to, the desired goal. This chapter begins with a presentation of indications for insulin therapy in type 2 diabetes. Normal physiological insulin patterns will be reviewed, highlighting how awareness of these patterns can guide the development of insulin treatment regimens. The next section will provide an overview of the characteristics of available insulin preparations. The chapter will end with a discussion of potential strategies for initiating and advancing insulin therapy.

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References

  1. Nathan DM, Buse JB, Davidson MB, et al. Management of hyperglycemia in type 2 diabetes: A consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2006; 29:1963–1972.

    Article  PubMed  Google Scholar 

  2. Ryan EA, Imes S, Wallace C. Short-term intensive insulin therapy in newly diagnosed type 2 diabetes. Diabetes Care 2004; 27:1028–1032.

    Article  CAS  PubMed  Google Scholar 

  3. Li Y, Xu W, Liao Z, et al. Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients is associated with improvement of beta-cell function. Diabetes Care. 2004; 27:2597–2602.

    Article  CAS  PubMed  Google Scholar 

  4. Ceglia L, Lau J, Pittas AG. Meta-analysis: efficacy and safety of inhaled insulin therapy in adults with diabetes mellitus. Ann Intern Med 2006; 145:665–675.

    PubMed  Google Scholar 

  5. AACE Diabetes Mellitus Clinical Practice Guidelines Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes mellitus. Endocr Pract 2007; 13(Suppl 1):1–68.

    Google Scholar 

  6. Plank J, Siebenhofer A, Berghold A, et al. Systematic review and meta-analysis of short-acting insulin analogues in patients with diabetes mellitus. Arch Intern Med 2005; 165:1337–1344.

    Article  CAS  PubMed  Google Scholar 

  7. Siebenhofer A, Plank J, Berghold A, et al. Short acting insulin analogues versus regular human insulin in patients with diabetes mellitus. Cochrane Database Syst Rev 2004(2):CD003287.

    Google Scholar 

  8. Gough SC. A review of human and analogue insulin trials. Diabetes Res Clin Pract 2007; 77:1–15.

    Article  CAS  PubMed  Google Scholar 

  9. Horvath K, Jeitler K, Berghold A, et al. Long-acting insulin analogues versus NPH insulin (human isophane insulin) for type 2 diabetes mellitus. Cochrane Database Syst Rev 2007(2):CD005613.

    Google Scholar 

  10. Meneghini LF, Rosenberg KH, Koenen C, et al. Insulin detemir improves glycaemic control with less hypoglycaemia and no weight gain in patients with type 2 diabetes who were insulin naive or treated with NPH or insulin glargine: clinical practice experience from a German subgroup of the PREDICTIVE study. Diabetes Obes Metab 2007; 9:418–427.

    Article  CAS  PubMed  Google Scholar 

  11. Philis-Tsimikas A, Charpentier G, Clauson P, et al. Comparison of once-daily insulin detemir with NPH insulin added to a regimen of oral antidiabetic drugs in poorly controlled type 2 diabetes. Clin Ther 2006; 28:1569–1581.

    Article  CAS  PubMed  Google Scholar 

  12. Raslova K, Tamer SC, Clauson P, et al. Insulin detemir results in less weight gain than NPH insulin when used in basal-bolus therapy for type 2 diabetes mellitus, and this advantage increases with baseline body mass index. Clin Drug Investig 2007; 27:279–285.

    Article  CAS  PubMed  Google Scholar 

  13. UK Hypoglycaemia Study Group. Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia 2007; 50:1140–1147.

    Google Scholar 

  14. Fritsche A, Schweitzer MA, Häring HU. Glimepiride combined with morning insulin glargine, bedtime neutral protamine hagedorn insulin, or bedtime insulin glargine in patients with type 2 diabetes. A randomized, controlled trial. Ann Intern Med 2003; 138:952–959.

    CAS  PubMed  Google Scholar 

  15. Janka HU, Plewe G, Riddle MC, et al. Comparison of basal insulin added to oral agents versus twice-daily premixed insulin as initial insulin therapy for type 2 diabetes. Diabetes Care 2005; 28:254–259.

    Article  CAS  PubMed  Google Scholar 

  16. Riddle MC, Rosenstock J, Gerich J; Insulin Glargine 4002 Study Investigators. The treat-to-target trial: randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients. Diabetes Care 2003; 26:3080–3086.

    Article  CAS  PubMed  Google Scholar 

  17. Yki-Jarvinen H. Combination therapies with insulin in type 2 diabetes. Diabetes Care 2001; 24:758–767.

    Article  CAS  PubMed  Google Scholar 

  18. Yki-Jarvinen H, Kauppinen-Mäkelin R, Tiikkainen M, et al. Insulin glargine or NPH combined with metformin in type 2 diabetes: the LANMET study. Diabetologia 2006; 49:442–451.

    Article  CAS  PubMed  Google Scholar 

  19. Yki-Jarvinen H, Ryysy L, Nikkilä K, et al. Comparison of bedtime insulin regimens in patients with type 2 diabetes mellitus. A randomized, controlled trial. Ann Intern Med 1999; 130:389–396.

    CAS  PubMed  Google Scholar 

  20. Cusi K, Cunningham GR, Comstock jP. Safety and efficacy of normalizing fasting glucose with bedtime NPH insulin alone in NIDDM. Diabetes Care 1995; 18:843–851.

    Article  CAS  PubMed  Google Scholar 

  21. Raskin P, Allen E, Hollander P, et al; INITIATE Study Group. Initiating insulin therapy in type 2 diabetes: a comparison of biphasic and basal insulin analogs. Diabetes Care 2005; 28:260–265.

    Article  CAS  PubMed  Google Scholar 

  22. Heine RJ, Van Gaal LF, Johns D, et al; GWAA Study Group. Exenatide versus insulin glargine in patients with suboptimally controlled type 2 diabetes: a randomized trial. Ann Intern Med 2005; 143:559–569.

    CAS  PubMed  Google Scholar 

  23. Yki-Jarvinen H, Kauppila M, Kujansuu E, et al. Comparison of insulin regimens in patients with non-insulin-dependent diabetes mellitus. N Engl J Med 1992; 327:1426–1433.

    Article  CAS  PubMed  Google Scholar 

  24. Riddle MC, Schneider J. Beginning insulin treatment of obese patients with evening 70/30 insulin plus glimepiride versus insulin alone. Glimepiride Combination Group. Diabetes Care 1998; 21:1052–1057.

    Article  CAS  PubMed  Google Scholar 

  25. Garber AJ, Wahlen J, Wahl T, et al. Attainment of glycaemic goals in type 2 diabetes with once-, twice-, or thrice-daily dosing with biphasic insulin aspart 70/30 (The 1-2-3 study). Diabetes Obes Metab 2006; 8:58–66.

    Article  CAS  PubMed  Google Scholar 

  26. Ligthelm RJ, Mouritzen U, Lynggaard H, et al. Biphasic insulin aspart given thrice daily is as efficacious as a basal-bolus insulin regimen with four daily injections: a randomised open-label parallel group four months comparison in patients with type 2 diabetes. Exp Clin Endocrinol Diabetes 2006; 114:511–519.

    Article  CAS  PubMed  Google Scholar 

  27. Davies M, Storms F, Shutler S, et al; ATLANTUS Study Group. Improvement of glycemic control in subjects with poorly controlled type 2 diabetes: comparison of two treatment algorithms using insulin glargine. Diabetes Care 2005; 28:1282–1288.

    Article  CAS  PubMed  Google Scholar 

  28. Yki-Jarvinen H, Juurinen L, Alvarsson M, et al. Initiate Insulin by Aggressive Titration and Education (INITIATE): a randomized study to compare initiation of insulin combination therapy in type 2 diabetic patients individually and in groups. Diabetes Care 2007; 30:1364–1369.

    Article  CAS  PubMed  Google Scholar 

  29. Schwartz S, Sievers R, Strange P, et al; INS-2061 Study Team. Insulin 70/30 mix plus metformin versus triple oral therapy in the treatment of type 2 diabetes after failure of two oral drugs: efficacy, safety, and cost analysis. Diabetes Care 2003; 26:2238–2243.

    Article  CAS  PubMed  Google Scholar 

  30. Triplitt C, Glass L, Miyazaki Y, et al. Comparison of glargine insulin versus rosiglitazone addition in poorly controlled type 2 diabetic patients on metformin plus sulfonylurea. Diabetes Care 2006; 29:2371–2377.

    Article  CAS  PubMed  Google Scholar 

  31. Strowig SM, Raskin P, Combination therapy using metformin or thiazolidinediones and insulin in the treatment of diabetes mellitus. Diabetes Obes Metab 2005; 7:633–641.

    Article  CAS  PubMed  Google Scholar 

  32. Peyrot M, Rubin RR, Lauritzen T, et al. The International DAWN Advisory Panel. Resistance to insulin therapy among patients and providers: results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study. Diabetes Care 2005; 28:2673–2679.

    Article  PubMed  Google Scholar 

  33. Rubin RR, Peyrot M. Quality of life, treatment satisfaction, and treatment preference associated with use of a pen device delivering a premixed 70/30 insulin aspart suspension (aspart protamine suspension/soluble aspart) versus alternative treatment strategies. Diabetes Care 2004; 27:2495–2497.

    Article  PubMed  Google Scholar 

  34. Freemantle N, Blonde L, Duhot D, et al. Availability of inhaled insulin promotes greater perceived acceptance of insulin therapy in patients with type 2 diabetes. Diabetes Care 2005; 28:427–428.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Tulane University Medical Center, New Orleans, Louisiana, USA

    Vivian A. Fonseca

  2. Harvard Medical School And Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Merri Pendergrass

  3. Tulane University Health Science Center Diabetes Program, New Orleans, Louisiana, USA

    Roberta Harrison McDuffie

Authors
  1. Vivian A. Fonseca
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  2. Merri Pendergrass
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  3. Roberta Harrison McDuffie
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Corresponding author

Correspondence to Vivian A. Fonseca .

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© 2009 Springer-Verlag London

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Fonseca, V.A., Pendergrass, M., McDuffie, R.H. (2009). Insulin in the management of type 2 diabetes. In: Diabetes in Clinical Practice. Springer, London. https://doi.org/10.1007/978-1-84882-103-3_4

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  • DOI: https://doi.org/10.1007/978-1-84882-103-3_4

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-102-6

  • Online ISBN: 978-1-84882-103-3

  • eBook Packages: MedicineMedicine (R0)

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