[Up to day trends in insulin therapy]

Area of Science:

• Endocrinology
• Cardiology
• Metabolic Diseases

Background:

• Patients with type 2 diabetes mellitus (T2DM) face a doubled risk of cardiovascular diseases (CVD), with two-thirds potentially succumbing to heart attack or stroke without risk factor intervention.
• Effective management strategies for T2DM include controlling blood pressure, cholesterol, glycemia, and smoking cessation to mitigate severe cardiovascular events.

Purpose of the Study:

• To emphasize that T2DM therapy should prioritize reducing cardiovascular complications and adverse effects, particularly hypoglycemia.
• To highlight the role of intensive insulin therapy in achieving normoglycemia and reducing both microangiopathic and cardiovascular risks.

Main Methods:

• Review of clinical studies such as DCCT/EDIC and UKPDS, documenting the benefits of intensive insulin therapy.
• Analysis of the ORIGIN study evaluating insulin glargine for safety and prevention of diabetes development from prediabetes.

Main Results:

• Intensive insulin therapy is vital for achieving normoglycemia and reducing microangiopathic complications.
• Long-acting insulin analogs, like insulin glargine, demonstrate safety and can reduce the incidence of new-onset diabetes from prediabetes.
• Positive outcomes from studies with insulin analogs support their role in T2DM management.

Conclusions:

• Insulin therapy, particularly with insulin analogs, is now recommended as a second-line treatment in T2DM algorithms, following metformin and lifestyle modifications.
• Therapeutic strategies must balance glycemic control with the reduction of cardiovascular risks and hypoglycemic events.