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Real gains but practical limitations to glycaemic control with insulin in type 2 diabetes

Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK

Susanna J Dunachie

Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, UK

Jonathan C Levy

Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK, jonathan.levy{at}drl.ox.ac.uk

Background

Insulin is increasingly used for type 2 diabetes when oral therapy is inadequate. We have examined the results in unselected patients in a UK hospital diabetes clinic.

Methods

Clinical database records from 1994 to 2002 were analysed for anthropomorphic data, blood pressure, HbA1C and plasma cholesterol in type 2 diabetic patients starting insulin therapy.

Results

In 335 patients, HbA _1C at four years correlated positively with HbA_1C before starting insulin (r=0.31, p<0.01) and negatively correlated with age at the time of starting insulin (r=-0.19, p<0.01). In two cohorts changed to insulin therapy before and after publication of the results of the UKPDS (1998), HbA1C improved in the first year, with little subsequent change over four years, while weight continued to rise. The later cohort had a significantly greater reduction in HbA_1C (p=0.001). Even in this group, only 21.6% of patients achieved HbA_1C < 7.5%.

Conclusions

In a UK diabetes clinic, insulin therapy for type 2 diabetes improved glycaemic control in the first year, but not thereafter, while weight gain continued in subsequent years. Tighter targets may have promoted improved results.

Key Words: type 2 diabetes • insulin therapy • HbA1C.

References

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• National Institute of Clinical Excellence. Management of type 2 diabetes. Inherited Clinical Guideline G 2002.
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The British Journal of Diabetes & Vascular Disease, Vol. 4, No. 2, 98-102 (2004)
DOI: 10.1177/14746514040040020601


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This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Gardner, S. Articles by Levy, J. C Search for Related Content Social Bookmarking                         What's this?