VA Studies Raise Key Issues about Trends in Type 2 Diabetes Treatment

Early Insulin, Singular Focus on HbA1c Not Always Best

By Brenda L. Mooney

NASHVILLE — New VA research soon might change the way clinicians treat veterans with type 2 diabetes.

Despite the increased push for early initiation of insulin in patients with type 2 diabetes, a new Nashville VA study suggests that might not always be a good idea. Another recent VA study, conducted by researchers in Michigan, questions whether the benefits of type 2 diabetes treatment are even worth the risks, side effects and inconvenience for some patients.


Christianne L. Roumie, MD, MPH

Among patients with diabetes who were receiving metformin, the addition of insulin compared with a sulfonylurea was associated with an increased risk of nonfatal cardiovascular outcomes and all-cause mortality, according to researchers from the Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center, and Vanderbilt University, both in Nashville. Their report was published recently in the Journal of the American Medical Association.1

Lead author Christianne L. Roumie, MD, MPH,explained that “adding insulin is a reasonable option for patients who desire fast or flexible blood sugar control. However, there’s no advantage on cardiovascular disease for adding insulin early. And we feel that most patients could be managed with a sulfonylurea as the second-line therapy.”

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