Lovre D, Fonseca V. Journal of Diabetes and its Complications. Doi: 10.1016/j.jdiacomp.2014.11.018
Chronic hyperglycaemia is associated with the micro and macro vascular complications of diabetes. Legacy studies from both DCCT and UKPDS have demonstrated long term reductions in macro vascular complications following early glucose control, not shown when glucose is controlled late in the condition – a situation which may even be harmful. Despite all the attention paid to newer agents, insulin remains the most potent hypoglycaemia agent and is most likely to safely maintain HbA1c<7% as well as attaining normoglycaemia in some newly diagnosed patients. Although cost is an issue, basal insulin analogues are associated with lower hypoglycaemia and weight gain compared with NPH insulin. Furthermore, patients can be taught how to titrate insulin quite easily although their acceptance of early insulin use can be an obstacle as can health care professional training. Finally, when combined with a GLP1 analogue, hypoglycaemia and weight gain can be further reduced. In fact, the next few years will see a number of products combined in a single device.