Do patients with Type 2 Diabetes (T2D) actually need insulin?

Do patients with Type 2 Diabetes (T2D) actually need insulin? Along comes a paper that makes you rethink one of the worlds most prescribed and expensive drugs.

Most Diabetes ‘authorities’ state that T2D is a chronic progressive disease and that patients will progress on to insulin.

Most patients that start insulin struggle with control of their blood glucose. Most put on weight and many have hypo’s (very low blood glucose) that can end with falls and hospitalisation.

But is insulin actually effective for T2D? It is essential for T1’s but may be not for T2D. Lowering carb intake makes more sense than adding in drugs like insulin.

This French meta analysis is very concerning.

The addition of insulin did not reduce the risk of death from any cause and especially not from cardiovascular disease or complications of micro vascular disease such as amputations and kidney failure.

It did show the problems of weight gain and hypo’s.

“Clinical efficacy of insulin needs to be demonstrated with long-term trials. Insulin is currently prescribed to millions of patients without a proven benefit. The only two long-term studies available have significant weaknesses.”

“It is noteworthy that insulin is the second cause of drug-related hospital admissions in patients over 65 [22]. In two U.S. representative surveys over a 4 year period, Geller and al. estimated there were nearly 100,000 emergency department visits per year for insulin-related hypoglycaemia and errors [23], among which almost one-third required hospitalization. The estimated rate of severe neurological sequelae was 60 %.

Patients over 80 treated with insulin were more than twice as likely to visit the emergency department and nearly 5 times as likely to be hospitalized. Moreover there is some evidence that hypoglycaemia may increase the risk of dementia.”

“Another well-known side effect of insulin-based regimen is weight gain, which secondarily increases insulin resistance.”

“The fact that insulin has shown no impact on clinically relevant outcomes is of major importance. Theoretically, insulin has potential negative clinical consequences, due to the underlying cellular and molecular mechanisms.”

“RESULTS: Twenty RCTs were included out of the 1632 initially identified studies. 18 599 patients were analysed: Insulin had no effect vs. hypoglycaemic drugs on all-cause mortality RR = 0.99 (95 % CI =0.92-1.06) and cardiovascular mortality RR = 0.99 (95 % CI =0.90-1.09), nor vs. diet/placebo RR = 0.92 (95 % CI = 0.80-1.07) and RR = 0.95 (95 % CI 0.77-1.18) respectively. No effect was found on secondary outcomes either. However, severe hypoglycaemia was more frequent with insulin compared to hypoglycaemic drugs RR = 1.70 (95 % CI = 1.51–1.91).”

“CONCLUSIONS: There is no significant evidence of long term efficacy of insulin on any clinical outcome in T2D. However, there is a trend to clinically harmful adverse effects such as hypoglycaemia and weight gain. The only benefit could be limited to reducing short term hyperglycemia. This needs to be confirmed with further studies.”