The Outcome Reduction with an Initial Glargine Intervention (ORIGIN) study was presented at the American Diabetes Association (ADA) meeting in June 2012 and simultaneously published in the NEJM. It was a large trial (>12,500 participants), which sought to establish if early use of basal analogue insulin, titrated according to fasting blood glucose levels, would reduce cardiovascular events. ‘Early use’ was certainly the case since 12% of subjects had ‘pre-diabetes’ and 6% were newly diagnosed, meaning that 40% of participants were on no hypoglycaemic therapy at baseline. All were, however, at high cardiovascular risk (defined according to a previous event or presence of risk factors such as albuminuria or left ventricular hypertrophy). Trial subjects received glargine or no treatment in an open design but were also randomised to double blind therapy with omacor or placebo to assess the impact of omega 3 fatty acids in this scenario.

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