CHICAGO-Insulin treatment without intensive intervention doesn’t guarantee tight glucose control for Type II diabetics, but a modest improvement may be enough for most.
In a University of Michigan outcome study of 8,668 patients treated by 80 generalists in a large HMO, Dr. Rodney Hayward saw declines of HbA1c averaging 0.9 after a year for insulin-treated patients, but 34% stayed over 9.0. Those on diet or sulfonylureas had a slight HbA1c rise.
But a companion risk analysis by Dr. Sandeep Vijan showed that less than 20% of patients-only those with early-onset Type II-may need intensive intervention and tight control to prevent most microvascular disease.
For older patients, a shift from poor to moderate control may do the same, the teams told the Midwest Society of General Internal Medicine meeting here. Insulin-treated patients had 2.4 more annual doctor visits and spent $200 more on home glucose testing. -Judy Ismach
