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Intensive insulin therapy: Too risky for type 2 diabetes?
A Mayo Clinic diabetes specialist answers questions about intensive insulin therapy and type 2 diabetes.
By Mayo Clinic staff
Intensive insulin therapy is an aggressive approach to diabetes treatment. In fact, intensive insulin therapy is the cornerstone of diabetes treatment for most people who have type 1 diabetes and some people who have type 2 diabetes. But now researchers are questioning the safety of intensive insulin therapy for type 2 diabetes. Here, Maria Collazo-Clavell, M.D., an endocrinologist specializing in diabetes at Mayo Clinic, Rochester, Minn., answers questions about intensive insulin therapy.
What is intensive insulin therapy?
Intensive insulin therapy is designed to prevent or slow the progression of long-term diabetes complications by keeping your blood sugar level as close to normal as possible. Intensive insulin therapy is recommended for most people who have type 1 diabetes and some people who have type 2 diabetes — but it isn't right for everyone.
If your doctor prescribes intensive insulin therapy, you'll need to closely monitor your blood sugar level and take frequent doses of insulin. You'll also need regular glycated hemoglobin (A1C) tests. The A1C test reflects your average blood sugar level for the past two to three months. With intensive insulin therapy, the goal is an A1C level as close to normal as possible.
The normal A1C range for people without diabetes is 4 percent to 6 percent. An A1C level less than 7 percent is a common target for people who have diabetes.
What do researchers know about intensive insulin therapy?
A study published in the New England Journal of Medicine in February 2008 found that a diabetes treatment plan that included intensive insulin therapy with an A1C level less than 6.5 percent reduced the risk of death overall, as well as death related to cardiovascular disease. Older studies stress specific benefits of tight blood sugar control with an A1C level less than 7.2 percent, such as reduced risk of diabetes-related eye, kidney and nerve complications.
On the flip side, intensive insulin therapy can lead to potentially dangerous episodes of low blood sugar (hypoglycemia). And now researchers for a government-sponsored trial called Action to Control Cardiovascular Risk in Diabetes (ACCORD) point out more serious safety concerns for intensive insulin therapy in type 2 diabetes.
Among 10,000-plus participants in the ACCORD trial, early analysis showed that 257 participants receiving intensive insulin therapy for type 2 diabetes with a target A1C level less than 6 percent had died since the beginning of the trial — compared with 203 participants receiving standard treatment with a target A1C level between 7 percent and 7.9 percent. About half the excess deaths were related to heart disease. Due to the possible risks, in February 2008 researchers halted the part of the trial that required intensive insulin therapy.
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