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May 20, 1998

Insulin Treatment for Type 2 Diabetes

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(19):1523-1526. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-19-jbk0520

To the Editor.—The article by Dr Hayward and colleagues1 found that the real-world effectiveness of instituting insulin therapy for patients with type 2 diabetes succeeded in lowering the HbA1c levels by about 1% in the hands of the primary care clinicians involved in the study. I share their sentiments that achieving tight glycemic control is often a difficult and resource-consuming endeavor. Their conclusion that "insulin therapy was largely ineffective in achieving tight glycemic control" struck me as remarkable. Why blame the drug for the relative ineffectiveness? If used appropriately, insulin therapy can be associated with near normal glycemic control in type 2 diabetes, as seen in the Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type II Diabetes.2 The mean insulin dose of 55 U/d in the Hayward study suggests that their investigators were using a good drug ineffectively, rather than using an ineffective drug. Numerous studies have indicated that near normal glycemic control can be achieved in patients with type 2 diabetes by using insulin doses of 0.5 to 1.0 U/kg per day, which most often translates to greater than 100 U/d.23

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