[Indication of intensive insulin therapy and its practice]

DCCT and Kumamoto Study demonstrated that optimal glycemic control with intensive insulin therapy could delay the onset and progression of the early stages of diabetic microvascular complications in Japanese patients with noninsulin dependent diabetes as well as in patients with insulin dependent diabetes mellitus. To obtain optimal glycemic control, the prandial insulin supplements before each meal are recommended for insulin requiring patients with noninsulin dependent diabetes mellitus whose residual B cell functions are retained to some extent, whereas the combined basal at bedtime plus prandial insulin supplements are essential for the patients with noninsulin dependent diabetes mellitus whose residual B cell functions are severely exhausted as well as in the patients with insulin dependent diabetes mellitus. The glycemic threshold to prevent the onset and progression of diabetic microvascular complications in the Kumamoto Study was indicated as follows; HbA1c < 6.5%, fasting blood glucose concentration < 110 mg/dl, and 2-hour postprandial blood glucose concentration < 180 mg/dl.