TY - JOUR
T1 - Early insulin treatment in type 2 diabetes: ORIGINal sin or valuable choice as ORIGINal treatment? An open debate on the ORIGIN study results
AU - Bolli, G. B.
AU - Consoli, A.
AU - Giaccari, Andrea
PY - 2012
Y1 - 2012
N2 - Diabetes is ultimately the result of relative or absolute insulin deficiency; insulin should therefore represent its "natural" treatment, from the very moment of diagnosis, or even earlier, such as any other hormonal deficiency. Insulin treatment, however, has been accused of the worst crimes, including that of fostering obesity, insulin resistance, atherosclerosis, and, lately, cancer. Are these charges real? Does insulin treatment truly carry in its nature the original sin of causing such terrible consequences? This unresolvable, past and present dispute has had important effects on our clinical behavior in insulin initiation in the management of Type 2 diabetes, and we all hoped that a specifically designed trial could help us on this controversy. The ORIGIN (Outcome Reduction with an Initial Glargine Intervention) trial aimed to establish whether an initial insulin treatment with glargine, as compared with standard treatments, was able to delay the onset of cardiovascular disease. Although the trial appeared negative, several viewpoints came out, alimenting the debate on how to analyze results from the ORIGIN trial and, ultimately, on the role of early insulin treatment in type 2 diabetes. In these pages we invited two experienced scientists to freely argument their interpretation of the trial, aiming to help our understanding of the consequences of the ORIGIN trial on insulin therapy.
AB - Diabetes is ultimately the result of relative or absolute insulin deficiency; insulin should therefore represent its "natural" treatment, from the very moment of diagnosis, or even earlier, such as any other hormonal deficiency. Insulin treatment, however, has been accused of the worst crimes, including that of fostering obesity, insulin resistance, atherosclerosis, and, lately, cancer. Are these charges real? Does insulin treatment truly carry in its nature the original sin of causing such terrible consequences? This unresolvable, past and present dispute has had important effects on our clinical behavior in insulin initiation in the management of Type 2 diabetes, and we all hoped that a specifically designed trial could help us on this controversy. The ORIGIN (Outcome Reduction with an Initial Glargine Intervention) trial aimed to establish whether an initial insulin treatment with glargine, as compared with standard treatments, was able to delay the onset of cardiovascular disease. Although the trial appeared negative, several viewpoints came out, alimenting the debate on how to analyze results from the ORIGIN trial and, ultimately, on the role of early insulin treatment in type 2 diabetes. In these pages we invited two experienced scientists to freely argument their interpretation of the trial, aiming to help our understanding of the consequences of the ORIGIN trial on insulin therapy.
KW - cardiovascular diseases
KW - diabetes
KW - hypoglycaemia
KW - major complication
KW - cardiovascular diseases
KW - diabetes
KW - hypoglycaemia
KW - major complication
UR - http://hdl.handle.net/10807/42572
UR - http://www.sciencedirect.com/science/article/pii/s0939475312002402#
U2 - 10.1016/j.numecd.2012.10.004
DO - 10.1016/j.numecd.2012.10.004
M3 - Article
SN - 0939-4753
VL - 22
SP - 1007
EP - 1012
JO - NMCD. NUTRITION METABOLISM AND CARDIOVASCULAR DISEASES
JF - NMCD. NUTRITION METABOLISM AND CARDIOVASCULAR DISEASES
ER -