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Need for insulin therapy in type II diabetes mellitus . A randomized trial . To identify patients with type II diabetes mellitus for whom insulin therapy is most beneficial , we conducted a randomized controlled trial in the general medicine clinic of a university hospital . Asymptomatic , obese , insulin-treated patients were given diet and diabetes education and , in half of these patients , insulin therapy was withdrawn . Over six months , patients developing hyperglycemic symptoms or acetonemia were counted as study failures . Failure criteria developed in 13 of 25 insulin-withdrawal patients , at a median of four weeks after withdrawal , compared with two of 24 control subjects . Elevated stimulated glucose levels predicted the need for insulin therapy . Hyperglycemia worsened in insulin-withdrawal patients who did not meet study failure criteria , but it improved in control patients . Study patients were insulin deficient as shown by low baseline C peptide values ( 0.43 +/- 0.05 nmol/L ) . The prompt metabolic decompensation precipitated by insulin withdrawal suggests that insulin-deficient patients may benefit from insulin therapy and may need it to prevent symptomatic hyperglycemia .
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Intervention_Pharmacological
insulin therapy
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Intervention_Pharmacological
insulin therapy
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Intervention_Educational
diet and diabetes education
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Intervention_Pharmacological
insulin therapy
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Outcome_Physical
hyperglycemic symptoms or acetonemia
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Outcome_Physical
Failure criteria
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Outcome_Physical
Elevated stimulated glucose levels
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Outcome_Physical
Hyperglycemia
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Outcome_Physical
baseline C peptide values
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Outcome_Physical
symptomatic hyperglycemia
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Participant_Condition
type II diabetes mellitus
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Participant_Condition
type II diabetes mellitus
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Participant_Condition
obese
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Participant_Sample-size
25 insulin-withdrawal
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Participant_Sample-size
24