July 19, 2006

PREFER - This Idiotically Designed Study will Set Back Diabetes Treatment for Years

Diabetes in Control reported this week on a study presented at the ADA conference this past June that could going to cause a lot of people to go blind and lose kidneys and toes.

[2006 American Diabetes Association Scientific Sessions : Liebl A et al. "Biphasic Insulin Aspart 30 (BIAsp30), Insulin Detemir (IDet) and Insulin Aspart (IAsp) Allow Patients with Type 2 Diabetes To Reach A1C Target: The PREFER Study" Presented June 11, 2006 Bretzel RG et al. "Equivalence of Basal Insulin Glargine vs Prandial Insulin Lispro for Glucose Control in Type 2 Diabetes Patients on Oral Agents - Results of the APOLLO Study" Presented June 12, 2006]

In brief, the study concludes that there is no reason for people with type 2 to use bolus insulin as the results of using a basal alone is comparable to a bolus/basal regime.

Why is this so dangerous? Because of the way the study was designed. What it really proved is that patients who don't use enough bolus insulin to control blood sugars will get little improvement from using bolus insulin. That's because the post-meal target in this study was 180 mg/dl, a level guaranteed to promote neuropathy in everyone and retinopathy in a lot of people with type 2. (Details of why can be found at Research Connecting Organ Damage with Blood Sugar Level)

This is, of course, the level the ADA has been pushing for years. One that the American College of Clinical Endocrinologists (AACE) has abandonned, because it is far too high.

Not only that, but the patients in this study were taken off ALL oral drugs, which of course meant that their insulin resistance went WAY up, making control that much harder.

The tragic thing is that insurers are likely to seize on this as a reason to deny coverage for bolus insulin to people with Type 2 diabetes.

Why doesn't ANYONE in the medical establishment get it that people with Type 2 deserve treatment that gives them NORMAL blood sugars, not those that ensure that most of them will suffer horribly for years?