Main Article Content
The timely insulin administration can promptly normalize the blood glucose level. Indications for early insulin therapy include severe insulin deficiency, often in young patients with low body weight; elderly people with sarcopenia and chronic infections; early manifestation of microvascular complications; insufficient effectiveness of two- or three-component combinations of anti-diabetic drugs; severe symptoms associated with hyperglycemia. Adequate insulin therapy reduces lipo- and glucotoxicity, protects beta cells, other tissues and organs from damage. At the same time, there is an opinion that, in view of adverse effects of exogenous insulin and appearance of new anti-diabetic drugs, the insulin therapy should be started as late as possible. Adverse effects include the risk of hypoglycemia, weight gain and possibly also cardiovascular complications. Combinations of insulin with other hypoglycemic drugs are discussed. There is a tendency for the target glycemic levels to increase with age. Obviously, the approach must be individual, taking into account the age, clinical and laboratory data, comorbidities and preferences of patients. Hyperinsulinemia itself can contribute to dyslipidemia and atherosclerosis. Severe hyperglycemia and other adverse effects are more likely with inadequate insulin therapy. In particular, weight gain is possible with long-acting and short-acting insulin mixtures. Correlation of the glucose-lowering effect of exogenous insulin with an increase in body weight was noted. In turn, severe hypoglycemia is associated with major adverse cardiovascular events, arrhythmias, and other complications. Finally, insulin therapy comes with a number of inconveniences, especially for older patients.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our edition uses the copyright terms of Creative Commons for open access journals.
Authors, who are published in this journal, agree with the following terms:
- The authors retain rights for authorship of their article and grant to the edition the right of first publication of the article on a Creative Commons Attribution 4.0 International License, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
- Directing the article for the publication to the editorial board (publisher), the author agrees with transmitting of rights for the protection and using the article, including parts of the article, which are protected by the copyrights, such as the author’s photo, pictures, charts, tables, etc., including the reproduction in the media and the Internet; for distributing; for the translation of the manuscript in all languages; for export and import of the publications copies of the writers’ article to spread, bringing to the general information.
- The rights mentioned above authors transfer to the edition (publisher) for the unlimited period of validity and on the territory of all countries of the world.
- The authors guarantee that they have exclusive rights for using of the article, which they have sent to the edition (publisher). The edition (the publisher) is not responsible for the violation of given guarantees by the authors to the third parties.
- The authors have the right to conclude separate supplement agreements that relate to non-exclusive distribution of their article in the form in which it had been published in the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.
- The policy of the journal permits and encourages the publication of the article in the Internet (in institutional repository or on a personal website) by the authors, because it contributes to productive scientific discussion and a positive effect on efficiency and dynamics of the citation of the article.
Hanefeld M, Fleischmann H, Siegmund T, Seufert J. Rationale for Timely Insulin Therapy in Type 2 Diabetes Within the Framework of Individualised Treatment: 2020 Update. Diabetes Ther. 2020 Aug;11(8):1645-1666. doi:10.1007/s13300-020-00855-5.
Weng J, Li Y, Xu W, et al. Effect of intensive insulin therapy on beta-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomised parallel-group trial. Lancet. 2008 May 24;371(9626):1753-60. doi:10.1016/S0140-6736(08)60762-X.
Pistrosch F, Köhler C, Schaper F, Landgraf W, Forst T, Hanefeld M. Effects of insulin glargine versus metformin on glycemic variability, microvascular and beta-cell function in early type 2 diabetes. Acta Diabetol. 2013 Aug;50(4):587-95. doi:10.1007/s00592-012-0451-9.
Jargin SV. Some aspects of the drug therapy of type 2 diabetes mellitus in overweight patients. Mìžnarodnij endokrinologìčnij žurnal. 2019;15(5):410-8. doi:10.22141/2224-07188.8.131.529.180046. (in Russian).
Davies MJ, D'Alessio DA, Fradkin J, et al. Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2018 Dec;41(12):2669-2701. doi:10.2337/dci18-0033.
Cosentino F, Grant PJ, Aboyans V, et al; ESC Scientific Document Group. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020 Jan 7;41(2):255-323. doi:10.1093/eurheartj/ehz486.
Buse JB, Wexler DJ, Tsapas A, et al. 2019 Update to: Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2020 Feb;43(2):487-493. doi:10.2337/dci19-0066.
Nyström T, Bodegard J, Nathanson D, Thuresson M, Norhammar A, Eriksson JW. Second line initiation of insulin compared with DPP-4 inhibitors after metformin monotherapy is associated with increased risk of all-cause mortality, cardiovascular events, and severe hypoglycemia. Diabetes Res Clin Pract. 2017 Jan;123:199-208. doi:10.1016/j.diabres.2016.12.004.
Cimmaruta D, Maiorino MI, Scavone C, et al. Efficacy and safety of insulin-GLP-1 receptor agonists combination in type 2 diabetes mellitus: a systematic review. Expert Opin Drug Saf. 2016 Dec;15(sup2):77-83. doi:10.1080/14740338.2016.1221402.
Eng C, Kramer CK, Zinman B, Retnakaran R. Glucagon-like peptide-1 receptor agonist and basal insulin combination treatment for the management of type 2 diabetes: a systematic review and meta-analysis. Lancet. 2014 Dec 20;384(9961):2228-34. doi:10.1016/S0140-6736(14)61335-0.
Wysham CH, Campos C, Kruger D. Safety and Efficacy of Insulin Degludec/Liraglutide (IDegLira) and Insulin Glargine U100/Lixisenatide (iGlarLixi), Two Novel Co-Formulations of a Basal Insulin and a Glucagon-Like Peptide-1 Receptor Agonist, in Patients With Diabetes Not Adequately Controlled on Oral Antidiabetic Medications. Clin Diabetes. 2018 Apr;36(2):149-159. doi:10.2337/cd17-0064.
Tang H, Cui W, Li D, et al. Sodium-glucose co-transporter 2 inhibitors in addition to insulin therapy for management of type 2 diabetes mellitus: A meta-analysis of randomized controlled trials. Diabetes Obes Metab. 2017 Jan;19(1):142-147. doi:10.1111/dom.12785.
Genuth S. Exogenous insulin administration and cardiovascular risk in non-insulin-dependent and insulin-dependent diabetes mellitus. Ann Intern Med. 1996 Jan 1;124(1 Pt 2):104-9. doi:10.7326/0003-4819-124-1_part_2-199601011-00005.
Malmberg K, Rydén L, Wedel H, et al; DIGAMI 2 Investigators. Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity. Eur Heart J. 2005 Apr;26(7):650-61. doi:10.1093/eurheartj/ehi199.
ORIGIN Trial Investigators; Gerstein HC, Bosch J, Dagenais GR, et al. Basal insulin and cardiovascular and other outcomes in dysglycemia. N Engl J Med. 2012 Jul 26;367(4):319-28. doi:10.1056/NEJMoa1203858.
ORIGIN Trial Investigators; Mellbin LG, Rydén L, Riddle MC, et al. Does hypoglycaemia increase the risk of cardiovascular events? A report from the ORIGIN trial. Eur Heart J. 2013 Oct;34(40):3137-44. doi:10.1093/eurheartj/eht332.
UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998 Sep 12;352(9131):837-53.
Wong MG, Perkovic V, Chalmers J, et al; ADVANCE-ON Collaborative Group. Long-term Benefits of Intensive Glucose Control for Preventing End-Stage Kidney Disease: ADVANCE-ON. Diabetes Care. 2016 May;39(5):694-700. doi:10.2337/dc15-2322.
Ismail-Beigi F, Craven T, Banerji MA, et al; ACCORD trial group. Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial. Lancet. 2010 Aug 7;376(9739):419-30. doi:10.1016/S0140-6736(10)60576-4.
Haghighatpanah M, Nejad ASM, Haghighatpanah M, Thunga G, Mallayasamy S. Factors that Correlate with Poor Glycemic Control in Type 2 Diabetes Mellitus Patients with Complications. Osong Public Health Res Perspect. 2018 Aug;9(4):167-174. doi:10.24171/j.phrp.2018.9.4.05.
Ghabban SJ, Althobaiti B, Farouk IM, et al. Diabetic Complications and Factors Affecting Glycemic Control Among Patients With Type II Diabetes Mellitus Attending the Chronic Illness Clinics at Tabuk, Saudi Arabia. Cureus. 2020 Nov 24;12(11):e11683. doi:10.7759/cureus.11683.
Duckworth W, Abraira C, Moritz T, et al; VADT Investigators. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009 Jan 8;360(2):129-39. doi:10.1056/NEJMoa0808431.
Diabetes Canada Clinical Practice Guidelines Expert Committee; Meneilly GS, Knip A, Miller DB, Sherifali D, Tessier D, Zahedi A. Diabetes in Older People. Can J Diabetes. 2018 Apr;42 Suppl 1:S283-S295. doi:10.1016/j.jcjd.2017.10.021.
Papa G, Fedele V, Chiavetta A, et al. Therapeutic options for elderly diabetic subjects: open label, randomized clinical trial of insulin glargine added to oral antidiabetic drugs versus increased dosage of oral antidiabetic drugs. Acta Diabetol. 2008 Mar;45(1):53-9. doi:10.1007/s00592-007-0023-6.
Kwon Y, Kim HJ, Park S, Park YG, Cho KH. Body Mass Index-Related Mortality in Patients with Type 2 Diabetes and Heterogeneity in Obesity Paradox Studies: A Dose-Response Meta-Analysis. PLoS One. 2017 Jan 3;12(1):e0168247. doi:10.1371/journal.pone.0168247.