How NOT to treat type 2 diabetes

Focus on the diabetes, not the blood glucose

By the mid 1990s, the landmark DCCT trial has established the paradigm of glucotoxicity, in type 1 but not in type 2 diabetes. Still euphoric from the trial’s success, it seemed only a matter of time before tight blood glucose control was proven beneficial in type 2 diabetes as well.

Nobody stopped to consider exactly how giving insulin to hyperinsulinemic patients was going to help. Nobody paused to consider that insulin toxicity might outweigh glucotoxicity. So, borrowing heavily from the type 1 diabetes playbook, the use of insulin is increasingly used for type 2 diabetes as well.

Over the last decade, the number of patients using insulin rose 50% as almost 1/3 of diabetic patients in the United States use some form of insulin overall. This is slightly horrifying, considering that 90–95% of diabetes in the United States is T2D, where the use of insulin is highly questionable.

In particular, the priority was to reduce cardiovascular disease. While type 2 diabetes is associated with numerous complications including nerve, kidney and eye damage, the morbidity and mortality associated with cardiovascular diseases dwarfed those by an order of magnitude. Simply put, most diabetic patients died of cardiovascular disease.

The United Kingdom Prospective Diabetes study, known as the UKPDS, was going to be the study that would prove the benefits of intensive blood glucose control. Almost…