Early Treatment with Basal Insulin Glargine in People with Type 2 Diabetes: Lessons from ORIGIN and Other Cardiovascular Trials
نویسندگان
چکیده
UNLABELLED Dysglycemia results from a deficit in first-phase insulin secretion compounded by increased insulin insensitivity, exposing β cells to chronic hyperglycemia and excessive glycemic variability. Initiation of intensive insulin therapy at diagnosis of type 2 diabetes mellitus (T2DM) to achieve normoglycemia has been shown to reverse glucotoxicity, resulting in recovery of residual β-cell function. The United Kingdom Prospective Diabetes Study (UKPDS) 10-year post-trial follow-up reported reductions in cardiovascular outcomes and all-cause mortality in persons with T2DM who initially received intensive glucose control compared with standard therapy. In the cardiovascular outcome trial, outcome reduction with an initial glargine intervention (ORIGIN), a neutral effect on cardiovascular disease was observed in the population comprising prediabetes and T2DM. Worsening of glycemic control was prevented over the 6.7 year treatment period, with few serious hypoglycemic episodes and only moderate weight gain, with a lesser need for dual or triple oral treatment versus standard care. Several other studies have also highlighted the benefits of early insulin initiation as first-line or add-on therapy to metformin. The decision to introduce basal insulin to metformin must, however be individualized based on a risk-benefit analysis. The landmark ORIGIN trial provides many lessons relating to the concept and application of early insulin therapy for the prevention and safe and effective induction and maintenance of glycemic control in type 2 diabetes. FUNDING Sanofi.
منابع مشابه
Long-term insulin glargine therapy in type 2 diabetes mellitus: a focus on cardiovascular outcomes
Cardiovascular disease is the leading cause of mortality in type 2 diabetes mellitus. Hyperinsulinemia is associated with increased cardiovascular risk, but the effects of exogenous insulin on cardiovascular disease progression have been less well studied. Insulin has been shown to have both cardioprotective and atherosclerosis-promoting effects in laboratory animal studies. Long-term clinical ...
متن کاملComment on: The ORIGIN Trial Investigators. Characteristics Associated With Maintenance of Mean A1C <6.5% in People With Dysglycemia in the ORIGIN Trial. Diabetes Care 2013;36:2915–2922
In their recently published Outcome Reduction with Initial Glargine Intervention (ORIGIN) trial (1), the investigators found that basal insulin glargine started early in the natural history of dysglycemia can maintain glycemic control near baseline levels for the whole study length. This trial is important for the size (12,537 individuals), geography (40 countries), and follow-up (up to 5 years...
متن کاملInsulin Use Early in the Course of Type 2 Diabetes Mellitus: The ORIGIN Trial
There has been a recent shift from a uniform treatment targeting HbA1c to a patient centered approach due to disappointing results of intensified glucose control in mega-trials such as VADT, ADVANCE, and ACCORD. In addition, morbidity and mortality has been substantially reduced since the UKPDS leading to an overestimation of the absolute risk for cardiovascular complications in randomized cont...
متن کاملA Review of Cardiovascular Outcomes in the Treatment of People with Type 2 Diabetes
INTRODUCTION Cardiovascular disease (CVD) is a common and serious complication of type 2 diabetes mellitus (T2DM) often linked to the increased morbidity and mortality associated with T2DM. Monitoring and treating risk factors for CVD are important elements of diabetes management. This review aims to examine CV risk in people with relatively early and mild diabetes who are at substantial risk o...
متن کاملResponse to Comment on: The ORIGIN Trial Investigators. Characteristics Associated With Maintenance of Mean A1C <6.5% in People With Dysglycemia in the ORIGIN Trial. Diabetes Care 2013;36:2915–2922
W e thank Drs. Esposito and Giugliano for their interest in the glycemic control results from ORIGIN (Outcome Reduction with Initial Glargine Intervention) (1), and their recognition of the potential importance of our findings. Citing their own systematic reviews of literature, they point out that the ability of insulin treatment to attain good control of A1C levels is strongly related to the l...
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