Comparison of Insulin Regimens in Patients with Non-Insulin-Dependent Diabetes Mellitus

Yki‐Järvinen, Hannele; Kauppila, Marjut; Kujansuu, Eila; Lahti, Jorma; Marjanen, Tapani; Niskanen, Leo; Rajala, Sulo; Ryysy, Leena; Salo, Seppo; Seppälä, P; Tulokas, Timo; Viikari, Jorma; Karjalainen, J.; Taskinen, Marja‐Riitta

doi:10.1056/nejm199211123272005

Cited by 305 publications

(171 citation statements)

References 26 publications

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“…The combination of insulin at bedtime with sulphonylurea drugs, as advocated in NIDDM [24][25][26], followed by NPH-insulin twice daily, appeared to be an effective, feasible and safe therapy regimen. The incidence rate of severe hypoglycaemia was low, 0.019/patient year for the whole group and 0.064/insulin treated patient year.…”

Section: Discussionmentioning

confidence: 99%

Sustained good glycaemic control in NIDDM patients by implementation of structured care in general practice: 2-year follow-up study

et al. 1997

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SummaryIn primary care it is difficult to treat the growing number of non-insulin-dependent diabetic (NIDDM) patients according to (inter)national guidelines. A prospective, controlled cohort study was designed to assess the intermediate term (2 years) effect of structured NIDDM care in general practice with and without 'diabetes service' support on glycaemic control, cardiovascular risk factors, general well-being and treatment satisfaction. The 'diabetes service', supervised by a diabetologist, included a patient registration system, consultation facilities of a dietitian and diabetes nurse educator, and protocolized blood glucose lowering therapy advice which included home blood glucose monitoring and insulin therapy. In the study group (SG; 22 general practices), 350 known NIDDM patients over 40 years of age (206 women; mean age 65.3 + SD 11.9; diabetes duration 5.9 + 5.4 years) were followed for 2 years. The control group (CG; 6 general practices) consisted of 68 patients (28 women; age 64.6 + 10.3; diabetes duration 6.3 + 6.4 years). Mean HbAtc (reference 4.3-6.1%) fell from 7.4 to 7.0% in SG and rose from 7.4 to 7.6 % in CG during follow-up (p = 0.004). The percentage of patients with poor control (HbAlc > 8.5 %) shifted from 21.4 to 11.7 % in SG, but from 23.5 to 27.9 % in CG (p = 0.008). Good control (HbAlc < 7.0 %) was achieved in 54.3 % (SG; at entry 43.4%) and 44.1% (CG; at entry 54.4%) (p = 0.013). Insulin therapy was started in 29.7 % (SG) and 8.8 % (CG) of the patients (p = 0.000) with low risk of severe hypoglycaemia (0.019/patient year). Mean levels of total and HDL-cholesterol (SG), triglycerides (SG) and diastolic blood pressure (SG + CG) and the percentage of smokers (SG) declined significantly, 'but the prevalence of these risk factors remained high. General well-being (SG) did not change during intensified therapy. Treatment satisfaction (SG) tended to improve. Implementation of structured care, including education and therapeutic advice, results in sustained good glycaemic control in the majority of NIDDM patients in primary care, with low risk of hypoglycaemia. Lowering cardiovascular risk requires more than reporting results and referral to guidelines. [Diabetologia (1997[Diabetologia ( ) 40: 1334[Diabetologia ( -1340

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Section: Discussionmentioning

confidence: 99%

Sustained good glycaemic control in NIDDM patients by implementation of structured care in general practice: 2-year follow-up study

et al. 1997

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“…Therapy should be intensified as needed with twice-daily split/mixed insulin, three times daily insulin therapy, or multiple daily injections to achieve glycemic goals. 20,119 Rapid-acting insulin is a new agent that is being used to achieve tight glycemic control in patients with type I diabetes; however, its role in type II diabetes is not yet defined.…”

Section: Insulinmentioning

confidence: 99%

Screening, prevention, counseling, and treatment for the complications of type II diabetes mellitus

et al. 1997

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PURPOSE:To summarize current knowledge of interventions that should improve the care of patients with type II diabetes mellitus. Interventions lie within the realms of prevention, screening, and treatment, all of which are focused on office practice. METHODS:Review of the literature by a multidisciplinary team involved in the care of patients with diabetes, followed by synthesis of the literature into a clinical care guideline. Literature was identified through consultation with experts and a focused MEDLINE search. MAIN RESULTS:An algorithm-based guideline for screening and treatment of the complications of diabetes was developed. The emphasis is on prevention of atherosclerotic disease, and prevention, screening, and early treatment of microvascular disease. Implementation of these practices has the potential to significantly improve quality of life and increase life expectancy in patients with type II diabetes mellitus. ype II diabetes is a common condition, affecting 2% to 3% of the adult population, and up to 20% to 25% of the elderly population. 1 Type II diabetes typically occurs in patients who are over 30 years old and weigh more than 120% of ideal body weight, and accounts for 90% of all cases of diabetes mellitus diagnosed in the United States. 1 Minorities have a prevalence of type II diabetes mellitus that is 2 to 6 times greater than that of white persons. The morbidity and mortality are higher for minorities than for white persons, and the rate is increasing. 2 The reasons for this disparity remain unclear, but could include differences in disease severity, comorbidities, or access to care.Diabetes has significant associated morbidity. Prevention and treatment of the complications of diabetes mellitus have the potential to improve quality of life and increase life expectancy. 3 The rate of cardiovascular disease is markedly elevated among patients with type II diabetes, leading to an increased mortality rate compared with the general population. 4,5 In addition, microvascular complications, which include retinopathy, nephropathy, and neuropathy, can progress to end-stage outcomes such as blindness, end-stage renal disease (ESRD), and amputation. Screening and early treatment for diabetic complications have been shown to be effective in reducing the incidence of end-stage disease 6,7 ; despite this evidence, implementation rates of recommended interventions are low. 8 This frequently leads to ineffective or delayed treatment of complications. 9-11 Because optimal diabetes care is a complex process, we developed a clinical care guideline to help busy clinicians incorporate prevention, screening, and treatment recommendations into practice. METHODSA multidisciplinary team was assembled to develop an evidence-based guideline for the prevention and treatment of complications of type II diabetes. The multidisciplinary team included members from endocrinology, family practice, general internal medicine, obstetrics-gyncecology, nursing, and postgraduate medicine departments. Team members have an interest ...

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“…There are several therapeutic schemes recommended for the treatment of type 2 diabetic patients. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Both non-insulinotropic and insulinotropic drugs are valid options for the crucial treatment of those patients with various pathophysiological origins of type 2 diabetes. 27 Because some degree of insulin deficiency is always present in an individual with diabetes type 2, we included metformin which is an agent known to influence insulin sensitivity without affecting insulin secretion.…”

Section: Discussionmentioning

confidence: 99%

Comparative Assessment of the Treatment of Type 2 Diabetes Mellitus

et al. 2002

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Comparison of Insulin Regimens in Patients with Non-Insulin-Dependent Diabetes Mellitus

Cited by 305 publications

References 26 publications

Sustained good glycaemic control in NIDDM patients by implementation of structured care in general practice: 2-year follow-up study

Sustained good glycaemic control in NIDDM patients by implementation of structured care in general practice: 2-year follow-up study

Screening, prevention, counseling, and treatment for the complications of type II diabetes mellitus

Comparative Assessment of the Treatment of Type 2 Diabetes Mellitus

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