Why, when and how to use insulin in type 2 diabetes mellitus

The United Kingdom Prospective Diabetes Study (UKPDS) was a landmark trial comparing intensive versus standard glycaemic control in patients newly diagnosed with type 2 diabetes mellitus (T2DM).¹ What clearly emerged was a reduction in microvascular disease (nephropathy, neuropathy, retinopathy) with lower HbA1C levels.

Later, in the UKPDS post-trial 10 year follow-up² a reduced incidence of myocardial infarction and all-cause mortality was found in the intensively treated group, even though glycaemic control had been no better than the standard group within 12 months of the trial completion. Thus it appears that early ‘good’ control of glycaemia provides lasting cardiovascular benefits, the so-called ‘legacy’ effect.