Insulin treatment in type 2 diabetic patients : epidemiological data

After several years of disease duration, blood glucose control is difficult without using insulin in type 2 diabetic patients. However, large differen ces are observed regarding the use of insulin from the south to the north o f Europe. A positive effect of insulin therapy on metabolic control compare d to oral antidiabetic agents is shown only in clinical trials performed on selected patients. As to degenerative complications, a great excess of ret inopathy is observed in insulin-treated patients in several surveys, withou t possibility to determine the specific effect of treatment from that of di sease severity, The UKPDS is the only randomised long term clinical trial w ith a large number of patients. The aim was to compare conventional to inte nsive antidiabetic treatment, whatever the type or drug, insulin or sulfony ureas. After a ten-year follow-up, glycemic control was better with the int ensive treatment, the microvascular complications less frequent by 25 %, bu t the benefit on cardiovascular complications or mortality was modest. Anot her clinical trial from US shows that a too strict insulin regimen could pe rhaps have no effect or even opposite to the objectives regarding cardiovas cular morbidity. Considering these clinical encertainties and the need for more definit long -term clinical data, it is justified to conduct additional long-term clinic al 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 insuli n treatment based on an individual assessment, particularly in older diabet ics, weighing the whole benefits and risks for a given patient of such an i mportant therapeutic change.