The feasibility of intensive insulin management in non-insulin-dependent diabetes mellitus: implications of the Veterans Affairs Cooperative Study on Glycemic Control and Complications in NIDDM

Article Abstract:

Evidence suggests that it is possible to effectively control blood sugar levels in male patients with non-insulin dependent diabetes mellitus (NIDDM). A researcher highlighted the results from a 27-month study designed to determine the feasibility of substantially reducing blood sugar levels in a group of 153 men with NIDDM. One group of patients followed a stepwise treatment plan aimed at reducing blood sugar levels (study group) while the other group continued on a standard diabetic treatment plan (control group). Forty percent of the study group reached normal blood sugar levels sometime during the study with 9.3% sustaining normal levels without substantial weight gain. However, only 3.9% of the control group ever reached normal blood sugar levels and none of them sustained normal levels. There were, however, many heart complications overall (26.1%). Based on these results, researchers plan a 7-year study to evaluate the long-term benefits and complications of aggressively managing blood sugar levels in patients with NIDDM.

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Glucose control and insulin resistance in non-insulin-dependent diabetes mellitus

Article Abstract:

A combination of insulin, diet, exercise, and antidiabetic medications may be necessary to manage blood sugar levels more tightly in obese patients with non-insulin dependent diabetes mellitus (NIDDM). Researchers presented several methods for controlling blood sugar levels in these patients. Studies have shown that patients with NIDDM can achieve normal blood sugar levels with high doses of insulin given either as a continuous or twice-daily injection. However, these treatments also resulted in high blood levels of insulin and significant weight gain (8.7 kilograms) despite efforts to control diet. Another study found that a combination dose of insulin with antidiabetic medication gave similar control of blood sugar levels but with less weight gain, particularly when the patient took the insulin in the evening. Exercise and weight loss can significantly reduce blood sugar levels but probably can not independently reduce them to recommended levels.

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Forum one: current recommendations about intensification of metabolic control in non-insulin-dependent diabetes mellitus

Article Abstract:

The health management of patients with non-insulin dependent diabetes mellitus (NIDDM) should involve aggressively managing blood sugar levels through a comprehensive team approach. A group of researchers and health professionals met to define the goals and recommendations of future treatment plans for patients with NIDDM. They agreed that a main goal in treating patients with NIDDM should be reaching and maintaining blood sugar levels within 1% of normal if patient health permits the aggressive treatment required to achieve this goal. Individually tailored treatment plans developed by a balanced health care team should also address diet, physical exercise, self-monitoring of sugar levels, controlling high blood pressure and cholesterol levels, and smoking habits. Organizations that fund the health care of patients with NIDDM should make the funds available to support these recommendations.

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