Optimal glycemic control in type 2 diabetic patients. Does including insulin treatment mean a better outcome?

Type 2 diabetes is a progressive disease with a significant risk for developing late complications. This article presents evidence related to the effect of glycemic control on the outcome of daily symptoms, microvascular complications, and macrovascular complications. Literature limited to Medline and the Cochrane Library was searched primarily for randomized clinical trials. In terms of education, present intervention studies indicate a positive effect on surrogate end points such as glycemic control, knowledge, practical skills, and psychological performance. Studies show improved glycemic control and plasma lipid profiles after moderate weight reduction. However, this positive effect is limited in time because weight is regained. With regard to oral blood glucose-lowering drugs, clinical trials show a significant blood glucose-lowering effect of different available drugs. Both sulfonylurea and metformin have been shown to significantly reduce the risk of microvascular complications. In the U.K. Prospective Diabetes Study, intensive treatment with metformin in obese subjects reduced the risk for any diabetes-related event and stroke. A major problem is that many patients gradually experience increasing hyperglycemia, creating the need for combined treatment with several drugs including insulin. Insulin treatment has been shown to be effective in achieving satisfactory glycemic control over several years. There is also a positive effect on hard end points such as microvascular disease in the eye, kidney, and nerves. In conclusion, present evidence shows that optimal glycemic control can be attained in people with type 2 diabetes, resulting in fewer disease-related symptoms and a reduced risk of late complications.