We have a really interesting item this week that bears reading more than once. Item #4 talks about using glimepiride with patients who are on insulin and how this may be safer and and better than adding more insulin. This article could be turned around to say we should start patients on insulin sooner. I am reminded of a conversation I had years ago with Dr. Matthew Riddle, when we were at the original Treat to Target meeting where Sanofi first announced their self-titrating protocol in 2001.
I asked Dr. Riddle why we would even want to start patients on insulin when we had more orals to chose from and he talked about resting the pancreas. His thought was that resting the pancreas during non feeding times would mean that there would be a better response to glucose challenges brought on by food and this would most likely have a positive effect on post-prandial readings, A1c, and beta-cell preservation.
Many of us have been following this idea for years and if you are considering whether to start a patient on insulin and want another reason why, you should really read this article.
If your patients are too needle-phobic to start on insulin or another injectable medication for diabetes you may be interested to know that researchers at University of Miyazaki have been successful in developing a nasal GLP-1 compound. According to the study publisher in Diabetes Care, "The Nasal GLP-1 induced early-phase insulin secretion, inhibition of inappropriate glucagon secretion, and improvement in intermediate-term markers of glycemic control without severe adverse events."
Dave Joffe, Editor-in-chief