Research Finds Insulin Ineffective For Many Diabetics

November 26, 1997

ANN ARBOR---People with type 2 diabetes are routinely encouraged to strictly control their blood sugar at near-normal levels, but a new study indicates this is extremely difficult to do through conventional use of insulin.

"Insulin therapy was found to be largely ineffective in achieving tight blood sugar control, even when combined with substantial increases in a patient's visits to the doctor's office and home blood sugar monitoring," said Rodney Hayward, M.D., leader of the study and an investigator at Veterans Affairs and the University of Michigan Health System.

The study's findings are published in the Nov. 26 issue of the Journal of the American Medical Association.

About nine out of 10 diabetics have type 2 diabetes, which means their pancreases produce some insulin, but not enough to meet their needs. In the U.S. alone, more than nine million people are diagnosed with type 2 diabetes---a leading cause of blindness, renal failure, and amputation in industrialized nations.

Thirty to 40 percent of type 2 diabetics are on insulin in an effort to improve blood sugar control and thereby reduce their risk of the disease's devastating complications. Previous research has demonstrated that carefully selected patients under close supervision can achieve strict blood sugar control with insulin, but this is the first study to evaluate how effective, safe and costly insulin treatment is in a more typical setting---when patient care is less intensive and managed by primary care doctors.

Here is a summary of the study's key findings and their ramifications:

---For type 2 diabetics with poor blood sugar control, starting insulin treatments significantly improved blood sugar control---but rarely approached the commonly recommended goal of near-normal control. "Much more aggressive treatment is needed for the 10 to 15 percent of patients who currently have poor glycemic control," Hayward said, "because, otherwise, they are at high risk of blindness, kidney failure and nerve damage." The study suggests insulin can help many of these patients reach a far safer moderate blood sugar level.

---For patients using pills to control their diabetes and maintaining moderate blood sugar control, administering insulin was only minimally effective, and did not move most patients into the near-normal range for blood sugar. That contradicts previous studies that indicated insulin can achieve tight blood sugar control---but those studies used volunteer subjects who likely were highly motivated to follow their medical regimen and received closer medical supervision and support than occurs in a typical clinical setting. These new findings suggest it would be difficult, troublesome and costly for most type 2 diabetics to achieve the tight control of blood sugar typically recommended.

---Most type 2 diabetics develop the disease later in life and maintain moderate control of their blood sugar, two factors which put them at relatively low risk of developing severe complications such as blindness and renal failure later in life. That risk often is less than one chance in 100.

Given the difficulty diabetics will have achieving the recommended tight control of blood sugar and the fact that most are at relatively low risk of developing serious complications, Hayward suggests the medical profession needs to reconsider whether the standard of tight glycemic control for virtually all diabetics is appropriate or necessary. "Achieving optimal blood sugar control with insulin requires either highly motivated patients, such as those likely to participate in experimental trials, or greater education and monitoring than can be accomplished in a patient's typical two to four annual visits to the doctor's office," Hayward said.

---In a study published earlier this month in the Annals of Internal Medicine, Hayward and colleagues at U-M demonstrated that people who develop type 2 diabetes at a relatively early age---before age 50, for example---are at far greater risk of ultimately losing their vision and kidney function than those whom the disease strikes later.

For those high-risk patients, the new research suggests insulin therapy will not be adequate to achieve the near-normal blood sugar levels needed to help lower their risk. "For this group, tight blood sugar control is a reasonable goal," Hayward said, "but more effective treatment approaches are likely to be needed."

One such treatment that is showing promise, he said, is a combination of insulin given at bedtime and oral medicine administered during the day. "High-risk patients, those who require tight blood sugar control to reduce future health complications, will need closer monitoring and more medical attention than most diabetics typically receive."

For this project, the investigators analyzed insulin use over a three- to four-year period among 1,738 patients treated by generalist physicians participating in a large health maintenance organization.

"Although it is disappointing that blood sugars did not return to near-normal levels on insulin, the results fit well with reports of many doctors with whom we have spoken over the last few years," said Sheldon Greenfield, a co-author of the study and director of the Primary Care Outcomes Research Institute at New England Medical Center and director of the Diabetes Patient Outcomes Research Team National Study, from which this analysis was drawn. "Physicians often feel guilty, frustrated or even inadequate after major efforts that include switching to insulin from an oral medication. They are also worried that national quality of care standards soon to be proposed will call for normalization of sugar in all patients."

The study was funded by the Agency for Health Care Policy and Research.

# # # # # #

University of Michigan

Related Diabetes Articles from Brightsurf:

New diabetes medication reduced heart event risk in those with diabetes and kidney disease
Sotagliflozin - a type of medication known as an SGLT2 inhibitor primarily prescribed for Type 2 diabetes - reduces the risk of adverse cardiovascular events for patients with diabetes and kidney disease.

Diabetes drug boosts survival in patients with type 2 diabetes and COVID-19 pneumonia
Sitagliptin, a drug to lower blood sugar in type 2 diabetes, also improves survival in diabetic patients hospitalized with COVID-19, suggests a multicenter observational study in Italy.

Making sense of diabetes
Throughout her 38-year nursing career, Laurel Despins has progressed from a bedside nurse to a clinical nurse specialist and has worked in medical, surgical and cardiac intensive care units.

Helping teens with type 1 diabetes improve diabetes control with MyDiaText
Adolescence is a difficult period of development, made more complex for those with Type 1 diabetes mellitus (T1DM).

Diabetes-in-a-dish model uncovers new insights into the cause of type 2 diabetes
Researchers have developed a novel 'disease-in-a-dish' model to study the basic molecular factors that lead to the development of type 2 diabetes, uncovering the potential existence of major signaling defects both inside and outside of the classical insulin signaling cascade, and providing new perspectives on the mechanisms behind insulin resistance in type 2 diabetes and possibly opportunities for the development of novel therapeutics for the disease.

Tele-diabetes to manage new-onset diabetes during COVID-19 pandemic
Two new case studies highlight the use of tele-diabetes to manage new-onset type 1 diabetes in an adult and an infant during the COVID-19 pandemic.

Genetic profile may predict type 2 diabetes risk among women with gestational diabetes
Women who go on to develop type 2 diabetes after having gestational, or pregnancy-related, diabetes are more likely to have particular genetic profiles, suggests an analysis by researchers at the National Institutes of Health and other institutions.

Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).

Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.

People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.

Read More: Diabetes News and Diabetes Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to