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Reevaluating goals of insulin therapy: perspectives from large clinical trials

Matthew C Riddle1, Kevin C J Yuen

  • 1Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mailcode L345, Portland, OR 97239, USA. riddlem@ohsu.edu

Endocrinology and Metabolism Clinics of North America
|May 12, 2012
PubMed

Insights

Intensive glycemic control helps prevent microvascular issues in type 2 diabetes. New goals and strategies are proposed to optimize insulin therapy for better macrovascular outcomes.

Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Clinical Trials

Background:

  • Intensive glycemic control reduces microvascular complications in type 2 diabetes.
  • Optimal glycemic targets for macrovascular outcomes in type 2 diabetes are not well-defined.
  • Understanding the natural history of type 2 diabetes is crucial for treatment strategies.

Purpose of the Study:

  • To survey recent studies on glycemic control in type 2 diabetes.
  • To examine the current understanding of type 2 diabetes natural history.
  • To propose new goals and tactics for insulin therapy optimization.

Main Methods:

  • Review of recent epidemiologic studies.
  • Analysis of interventional clinical trials.
  • Synthesis of current knowledge on type 2 diabetes progression.

Main Results:

  • Evidence supports microvascular complication reduction with intensive control.
  • Macrovascular outcome benefits require further definition of glycemic goals.
  • Current understanding necessitates updated therapeutic approaches.

Conclusions:

  • Glycemic goals need refinement for macrovascular benefit in type 2 diabetes.
  • Optimizing insulin therapy requires new strategies.
  • Further research is needed to define safe and effective glycemic targets.

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