Insulin treatment can safely be instituted in elderly patients with NIDDM. However, it is difficult to obtain optimal glycemic control. Insulin has moderate beneficial effects on serum lipoproteins. Although on the basis of glycemic control and weight gain, no preference for any treatment regimen can be discerned, twice-daily insulin administration is the most simple and cost-effective regimen.

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The effects of improved blood glucose control by insulin therapy on lipoprotein(a) and other lipoproteins were studied in 54 patients with Type 2 diabetes (mean +/- SD: age 67 +/- 9 years, body mass index 26.1 +/- 4.4 kg m-2, median duration of diabetes 10 (range 1-37) years, 23 males, 31 females), who were poorly controlled despite diet and maximal doses of oral hypoglycaemic agents. After 6 months of insulin treatment, mean fasting blood glucose concentrations had decreased from 14.1 +/- 2.2 mmol l-1 to 8.4 +/- 1.8 mmol l-1 (p < 0.001), and HbA1c had fallen from 11.1 +/- 1.4% to 8.2 +/- 1.1% (p < 0.001). Significant decreases of total and LDL cholesterol, triglycerides, apolipoprotein B, and free fatty acids were observed, while HDL-cholesterol and apoA1 increased by 10%. Baseline serum Lp(a) levels were elevated compared to non-diabetic subjects of similar age (median 283, range 8-3050 mg l-1, vs 101, range 8-1747 mg l-1, p < 0.05), but did not change with insulin, and there was no correlation with the degree of metabolic improvement and changes in Lp(a) levels. It is concluded that improved blood glucose control by insulin therapy does not alter elevated Lp(a) levels in Type 2 diabetic patients, but has favourable effects on the other lipoproteins.

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