|ISSN No. 1021-3538 Vol.8 No.1 April 2000|
|Intensive glycaemic control in type 2 diabetes mellitus with focus on insulin therapy|
Abdulamir A Al- Ashbal
Department of Medicine, Saddam Teaching Hospital, Al Qadisyiah Governorate, Iraq
Type 2 diabetes mellitus is a heterogeneous disease and is probably characterised by different pathogenic mechanisms and variable contribution of insulin resistance and insulin deficiency.1-4 Moreover, the mix of insulin resistance and insulin deficiency is likely to be different in each patient and in any patient, may vary during the course of the disease.4,5 In turn, chronic hyperglycaemia can impair both insulin-secretory response to glucose and cellular insulin sensitivity (i.e., glucose toxicity).4,6-8 Epidemiological and clinical data have unequivocally emphasised the relationship between long-term metabolic control and the incidence and progression of diabetic microvascular complications such as retinopathy, nephropathy and neuropathy in both Type 1 and Type 2 diabetes.9-10 There are several associations and correlations between hyperglycaemia and macrovascular disease11-23 and a role for hyperglycaemia in the pathogenesis of atherosclerosis and thrombosis ispostulated.24-34 Epidemiological studies have found that insulin is integral to the management of about 30% to 40% of patients with Type 2 diabetes.35-36 Insulin is temporarily required to control hyperglycaemia during severe stress (e.g., injury, infection, surgery) or in pregnancy, but in majority insulin therapy is aimed at reducing long-term complications. Data from long-term interventional studies37-39 and others from short-term interventional studies40-51 have shown that intensive glycaemic control is feasible and beneficial in reducing microvascular complications among patients with Type 2 diabetes. The aim of this review is to provide evidence for the importance of good glycaemic control in Type 2 diabetes, with a focus on insulin therapy.