Pro's and Con's of the early use of insulin in the management of type 2 diabetes: a clinical evaluation

Abstract

Purpose of Review Recently, there have been increasing calls for insulin to be used as the initial treatment of type 2 diabetes, and if not then, soon after its onset. The underlying reason given is that insulin will slow apoptosis of pancreatic β-cells which is increased in type 2 diabetes. This review will examine the clinical evidence supporting this recommendation. Recent Findings Several observational studies in which newly diagnosed type 2 diabetic patients are intensively treated for a short time with insulin which is then stopped have shown that approximately half of these patients retain good control without pharmacological therapy for up to a year. However, Hb A1c levels in patients who have to be started on oral anti-diabetic drugs (OAD) are similar to the values in those who do not. Hb A1c levels are similar in patients randomized to initial therapy with insulin or OAD. There is no clinical evidence yet for an effect of insulin on β-cell apoptosis. Summary The primary goal is to achieve and maintain Hb A1c levels of <7.0%. Given the extra demands on both patients and physicians when starting insulin compared to OAD and the many subsequent years in which patients have diabetes, the arguments for using insulin initially, or in patients who have achieved the target Hb A1c level, are not convincing. However, as soon as OAD therapy cannot meet this goal, insulin must be introduced.

Intestinal permeation enhancers for oral peptide delivery

“…and low values (1)(2)(3)(4)(5)(6)(7)(8)(9)(10) [165]. The hydrophobic moiety of the surfactant also influences enhancement action.…”

“…improved absorption of heparin following jejunal delivery in rats in vivo [279]. These data are not surprising as the most effective non-ionic surfactants tested in oral peptide delivery have similar hydrocarbon (C 8 -12 ) and ethoxylate ( [8][9][10][11][12][13][14][15][16][17][18][19][20] ) chain length [280]. Not all ethoxylated lipoidal vehicles alter intestinal permeability, for example, Kolliphor® EL (BASF, Germany) [281] and Cremophor® RH60 [282] are poor PEs.…”

Short‐term intensive insulin therapy at diagnosis in type 2 diabetes: plan for filling the gaps

“…), there are a number of important unanswered questions. Although recent reviews have also been largely supportive of the STII therapy concept , existing evidence needs to prove that sufficient additional clinical benefit exists to offset the expense and resources required to successfully implement STII therapy in routine practice . This may well be in line with the prevailing opinion of many health care practitioners.…”