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Insulin use in NIDDM.

S Genuth1

  • 1Case Western Reserve University, Mt. Sinai Medical Center, Cleveland, Ohio.

Diabetes Care
|December 1, 1990
PubMed
Summary
This summary is machine-generated.

Insulin therapy can improve non-insulin-dependent diabetes mellitus (NIDDM) by reducing glucose output and improving insulin sensitivity. While beneficial, potential risks like hypoglycemia and weight gain require careful management.

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Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Pharmacology

Background:

  • Non-insulin-dependent diabetes mellitus (NIDDM) is characterized by insulin resistance and impaired insulin secretion.
  • The role of insulin therapy in managing NIDDM pathophysiology is a subject of ongoing research and clinical debate.

Purpose of the Study:

  • To review the effects of insulin treatment on the pathophysiology of non-insulin-dependent diabetes mellitus (NIDDM).
  • To evaluate the indications, benefits, and adverse effects of insulin therapy in NIDDM patients.

Main Methods:

  • Review of short-term and prospective randomized studies.
  • Analysis of clinical outcomes, including glycemic control, beta-cell function, and insulin resistance.
  • Examination of adverse effects such as hypoglycemia, weight gain, and potential cardiovascular risks.

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Main Results:

  • Insulin treatment shows variable efficacy in reducing hepatic glucose output and insulin resistance, potentially due to decreased glucose toxicity.
  • Insulin is indicated for new-onset NIDDM with ketosis, significant weight loss, or severe symptoms, and is comparable or slightly advantageous to sulfonylureas in diet-failure patients.
  • Potential benefits of bedtime insulin injections and combination therapy with sulfonylureas are under investigation, while risks include hypoglycemia and weight gain, with controversial links to cardiovascular disease.

Conclusions:

  • Insulin therapy can be a valuable tool in managing NIDDM, particularly in specific clinical scenarios.
  • Careful patient selection, monitoring, and consideration of potential adverse effects are crucial for optimizing insulin treatment outcomes.
  • Further research is needed to clarify the long-term benefits and risks, including the potential atherogenic effects of insulin.