Long-Term Intervention Studies Using Insulin in Patients with Type 1 Diabetes

Abstract

To discuss data from long-term intervention studies regarding therapy in type 1 diabetes and review strategies for preventing hypoglycemia and safely achieving glycemic goals in this patient population. The shortcomings of traditional models of insulin therapy are elucidated, and the need for physiologic insulin replacement is emphasized. An estimated more than 10 million patients will have type 1 diabetes worldwide within the next 20 years. Twice-daily injection of premixed or self-mixed insulin is the most common insulin regimen; however, this therapeutic strategy is also a major contributor to hypoglycemia and, eventually, hypoglycemia unawareness. Hypoglycemia unawareness in patients with type 1 diabetes has been found to be largely reversible. Moreover, intensive insulin therapy may prevent hypoglycemia and maintain glycemic targets. The most physiologic regimen of insulin available is continuous subcutaneous insulin infusion with an insulin pump; however, insulin glargine is a useful alternative to pump therapy. Use of today's rapid- and long-acting insulin analogues in intensive management protocols not only improves glycemic control but also reduces the risk of hypoglycemia. Therefore, safe achievement and maintenance of target glycemic goals are possible.