Insulin has no long-term benefit in type 2 diabetes, according to a large combined analysis of randomised controlled trials.

And it is likely to cause hypoglycaemic (low blood sugar) events or major hypoglycaemia compared with oral hypoglycaemic drugs, the French researchers report.

Their analysis of 20 randomised controlled trials involving over 18,000 patients shows insulin treatment did not affect death from all causes or death from cardiovascular causes, such as heart attack and stroke, compared with placebo dummy treatment or diet alone.

Insulin treatment further did not decrease relevant outcomes such as blindness and renal failure compared with placebo or diet alone.

Insulin treatments analysed in the meta-analysis include insulin only or insulin combined with another oral agent.

“Clinical efficacy of insulin [in type 2 diabetes] needs to be demonstrated with long-term trials. Insulin is currently prescribed to millions of patients without a proven benefit,” the researchers write in the journal BMC Endocrine Disorders.

They claim 2 long-term studies comparing insulin with oral medications have significant methodological weaknesses and used insulin treatment regimens different from current regimens.

The researchers say many studies have shown a serious risk of hypoglycaemia linked with insulin use, making insulin a “high risk treatment option”.

They argue insulin should only be used in type 2 diabetes to reduce short-term hyperglycaemia and to avoid acute complications like infection or hyperosmolar coma.

And they take aim at the “treat to target” model, saying the push for low HbA1c levels has led to more patients with type 2 diabetes being prescribed insulin.

The Australian Diabetes Society’s position statement recommends insulin treatment as a third-line option when other oral therapies fail to achieve glycaemic targets.  

Last Reviewed: 11/07/2016



Efficacy and safety of insulin in type 2 diabetes: meta-analysis of randomised controlled trials