Insulin treatment in type 2 diabetes mellitus

Year 2012, Volume: 29 Issue: 1s, 44 - 48, 21.06.2012

M. Hulusi Atmaca

https://doi.org/10.5835/jecm.omu.29.s1.009

Abstract

Insulin is the most effective available medication for treating hyperglycemia in type 2 diabetes. If appropriately used, it can decrease any level of elevated HbA1C to, or close to, the desired goal. Whereas insulin therapy is required in all patients with type 1 diabetes, the decision of how and when to start insulin in type 2 diabetes is not as straightforward. Insulin usually should be started immediately in patients with marked weight loss, severe hyperglycemia, or ketosis. In the absence of these features, insulin should be added when glycemic goals are not met with one or more non-insulin agents, or when glycemic goals are unlikely to be achieved with non-insulin therapy. After the glucose is controlled and symptoms are relieved, it may be possible to withdraw the insulin or to be continued. Here, insulin therapy in patients with type 2 diabetes will be briefly reviewed.

Keywords

Type 2 Diabetes, Human insulins, Analoque insulins, Basal insulin, Bolus insulin, Biphasic insulin

Tip 2 diabetes mellitusta insülin tedavisi

Abstract

İnsülin, tip 2 diyabetteki hiperglisemi tedavisinde mevcut tedaviler içerisinde en etkili olanıdır. Uygun şekilde kullanıldığında, artmış HbA1C’yi arzulanan hedefe düşürebilir. Tüm tip 1 diyabetiklere insulin tedavisi gerekli iken, tip 2 diyabetiklerde insulin tedavisinin nasıl olacağı veya ne zaman başlanacağı konusu o kadar açık değildir. Belirgin kilo kaybı, ciddi hiperglisemi veya ketosis durumlarında insulin hemen başlanmalıdır. Bu durumların dışında, insulin dışındaki tedavilerle veya bir veya daha fazla non-insülin ajanlarla glisemik hedeflere ulaşılamıyorsa insülin tedavisi eklenmelidir. Glukoz kontrolü sağlandıktan ve semptomlar düzeldikten sonra insulin tedavisi kesilebilir veya devam edilebilir. Burada kısaca tip 2 diyabette insulin tedavisi gözden geçirilecektir.

Keywords

Tip 2 Diyabet, İnsan insülinleri, Analog insülinler, Bazal insülin, Bolus insülin, Bifazik insülin

References

• Clements, M.R., Tits, J., Kinsley, B.T., Råstam, J., Friberg, H.H., Ligthelm, R.J., 2008. Improved glycaemic control of thrice-daily biphasic insulin aspart compared with twice-daily biphasic human insulin; a randomized, open-label trial in patients with type 1 or type 2 diabetes. Diabetes Obes. Metab. 10, 229-237.
• DCCT (The Diabetes Control and Complications Trial Research Group), 1993. The effect of intensive treatment of diabetes on the development and progression of long- term complications in insulin-dependent diabetes mellitus. N. Engl. J. Med. 329, 977-986.
• Garvey, W.T., Olefsky, J.M., Griffin, J., Hamman, R.F., Kolterman, O.G., 1985. The effect of insulin treatment on insulin secretion and insulin action in type II diabetes mellitus. Diabetes. 34, 222-234.
• Haak, T., Tiengo, A., Draeger, E., Suntum, M., Waldhäusl, W., 2005. Lower within-subject variability of fasting blood glucose and reduced weight gain with insulin detemir compared to NPH insulin in patients with type 2 diabetes. Diabetes. Obes. Metab. 7, 56-64.
• Henry, R.R., Gumbiner, B., Ditzler, T., Wallace, P., Lyon, R, Glauber, H.S., 1993. Intensive conventional insulin therapy for type II diabetes. Metabolic effects during a 6-mo outpatient trial. Diabetes Care 16, 21-31.
• Hermansen, K., Davies, M., Derezinski, T., Martinez, R.G., Clauson, P., Home, P., 2006. A 26-week, randomized, parallel, treat-to-target trial comparing insulin detemir with NPH insulin as add-on therapy to oral glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabetes Care 29, 1269-1274.
• Ilkova, H., Glaser, B., Tunçkale, A., Bagriaçik, N., Cerasi, E., 1997. Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients by transient intensive insulin treatment. Diabetes Care 20, 1353-1356.
• İmamoğlu, Ş., Ersoy, C.Ö., 2009. Diabetes mellitus’ta insülin tedavisi. Diabetes Mellitus, 2. baskı, İmamoğlu, Ş., Ersoy, C.Ö, eds. Deomed, İstanbul, pp.178-188.
• Leslie, R.D., Elliott, R.B., 1994. Early environmental events as a cause of IDDM. Evidence and implications. Diabetes 43, 843-850.
• Li, Y., Xu, W., Liao, Z., Yao, B., Chen, X., Huang, Z., Hu, G., Weng, J., 2004. Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients is associated with improvement of beta-cell function. Diabetes Care 27, 2597-2602.
• McCulloch, D.K., Nathan, D.M., Ocak 2010, http://www.uptodate.com/contents/insulin-therapy-in-type-2-diabetes-mellitus.
• McCulloch, D.K., Nathan, D.M., Mulder, J.E., Şubat 2011. General principles of insulin therapy in diabetes mellitus. http://www.uptodate.com/ contents/general-principles-of- insulin-therapy-in-diabetes-mellitus.
• Nathan, D.M., Cleary, P.A., Backlund, J.Y., Genuth, S.M., Lachin, J.M., Orchard, T.J., Raskin, P., Zinman, B., 2005. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N. Engl. J. Med. 22, 2643-2653.
• Nathan, D.M., Buse, J.B., Davidson, M.B., Heine, R.J., Holman, R.R., Sherwin, R., Zinman, B., 2006. Management of hyperglycemia in type 2 diabetes: A consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 29, 1963-1972.
• Philis-Tsimikas, A., Charpentier, G., Clauson, P., Ravn, G.M., Roberts, V.L., Thorsteinsson, B., 2006. Comparison of once-daily insulin detemir with NPH insulin added to a regimen of oral antidiabetic drugs in poorly controlled type 2 diabetes. Clin. Ther. 28, 1569-1581.
• Plank, J., Siebenhofer, A., Berghold, A., Jeitler, K., Horvath, K., Mrak, P., Pieber, T.R., 2005. Systematic review and meta-analysis of shortacting insulin analogues in patients with diabetes mellitus. Arch. Intern. Med. 165, 1337-1344.
• Qayyum, R., Bolen, S., Maruthur, N., Feldman, L., Wilson, L.M., Marinopoulos, S.S., Ranasinghe, P., Amer, M., Bass, E.B., 2008. Systematic review: Comparative effectiveness and safety of premixed insulin analogues in type 2 diabetes. Ann. Intern. Med. 149, 549-559.
• Riddle, M.C., Rosenstock, J., Gerich, J., 2003. Insulin Glargine 4002 Study Investigators. The treat-to-target trial: Randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients. Diabetes Care 26, 3080-3086.
• Rosenstock, J., Davies, M., Home, P.D., Larsen, J., Koenen, C., Schernthaner, G., 2008. A randomised, 52-week, treat-to-target trial comparing insulin detemir with insulin glargine when administered as add-on to glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabetologia 51,408-416.
• Rosenstock, J., Schwartz, S.L., Clark, C.M., Jr Park, G.D., Donley, D.W., Edwards, M.B., 2001. Basal insulin therapy in type 2 diabetes: 28-week comparison of insulin glargine (HOE 901) and NPH insulin. Diabetes Care 24, 631-636.
• Ryan, E.A., Imes, S., Wallace, C., 2004. Short-term intensive insulin therapy in newly diagnosed type 2 diabetes. Diabetes Care 27, 10281032.
• Skyeler, J.S., 2004. Insulin therapy. Therapy for diabetes mellitus and related disorders, 4th ed., Lebovitz, H.E., ed. American Diabetes Association, Inc., pp.211-227.
• Taylor, R., Davies, R., Fox, C., Sampson, M., Weaver, J.U., Wood, L., 2000. Appropriate insulin regimes for type 2 diabetes: A multicenter randomized crossover study. Diabetes Care 23, 1612-1618.
• TEMD (Türkiye Endokrinoloji ve Metabolizma Derneği), Diabetes Mellitus Çalışma Grubu, Diabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu, 2010.
• UKPDS (UK Prospective Diabetes Study) Group,1998. 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 352, 837-853.
• Yki-Järvinen, H., Kauppinen-Mäkelin, R., Tiikkainen, M., Vähätalo, M., Virtamo, H, Nikkilä, K., Tulokas, T., Hulme, S., Hardy, K., McNulty, S., Hänninen, J., Levänen, H., Lahdenperä, S., Lehtonen, R., Ryysy, L., 2006. Insulin glargine or NPH combined with metformin in type 2 diabetes: The LANMET study. Diabetologia 49, 442-451.