While GPs� understanding of the definition of insulin resistance is excellent (85% know it is the inability of the body to respond to its own insulin1), the number of patients that it affects is being greatly underestimated. An independent survey carried out by Taylor Nelson Sofres* has revealed that 60% of GPs and 85% of practice nurses are unaware that at least 92% of people with type 2 diabetes are insulin resistant 1,2,3.
Eighty-seven percent of GPs understand that insulin resistance is related to the development of cardiovascular complications.1 However, it may be extremely difficult to optimise treatment without widespread appreciation of the prevalence of insulin resistance in type 2 diabetes.
�Cardiovascular disease is the principal cause of death amongst these patients4. Treatment of insulin resistance improves glycaemic control and the UKPDS study has shown that maintenance of glycaemic control may reduce the risks of CV complications associated with type 2 diabetes5,6,� comments Dr Peter Tasker of Primary Care Diabetes UK. �New treatments that increase the body�s sensitivity to insulin address this problem and may therefore impact on cardiovascular risk factors. If the prevalence of insulin resistance in type 2 diabetes patients is not appreciated it could be hard to optimise treatment.�
This view is supported by further survey data. Research has shown that increasing the body�s sensitivity to its own insulin using drugs such as AVANDIA (rosiglitazone) � a member of the thiazolidinedione (TZD) class of oral antidiabetic agents � can result in improved glycaemic control7,8. Studies have also shown that AVANDIA has positive effects on a range of cardiovascular risk factors9-13. However, the survey shows only 10% of GPs questioned would introduce a TZD in a patient found to be uncontrolled using conventional monotherapy1**, perhaps meaning that the full potential of available treatments is not being realised.
These survey results highlight the need for greater understanding of the prevalence of insulin resistance to enable GPs to make informed treatment decisions.
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* Survey commissioned by GlaxoSmithKline - carried out using the Taylor Nelson Sofres Omnimed service
**Conventional monotherapy treatment of type 2 diabetes is treatment with either metformin or sulphonylureas
- Data on file. GP type 2 diabetes survey, commissioned by GlaxoSmithKline. September 2001.
- Data on file. Practice nurse type 2 diabetes, commissioned by GlaxoSmithKline. September 2001.
- Haffner SM et al. Insulin sensitivity in subjects with type 2 diabetes. Relationship to cardiovascular risk factors: the Insulin Resistance Atherosclerosis Study. Diabetes Care 1999; 22:562-568.
- British Diabetic Association. The Kings Fund. Counting the costs; the real impact of non insulin dependent diabetes mellitus.1996.
- UKPDS. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35) : prospective observational study. BMJ 2000;321:405-412.
- UKPDS. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998; 352:854-865
- Jones NP et al. Long-term efficacy of rosiglitazone as monotherapy or in combination with metformin. Diabetologia 2000;43 (supplement 1) A192, Abs 736.
- Data on file. SmithKline Beecham. Long term efficacy of rosiglitazone added to sulphonylureas (AVDF0330A). 2000.
- Bakris GL et al. Rosiglitazone improves blood pressure in patients with type 2 diabetes mellitus. Diabetes 2000. 49(supplement1): A96, Abs 388
- Data on file. SmithKline Beecham. AVANDIA summary of product characteristics. 2001.
- Bakris GL et al. Rosiglitazone produces long-term reductions in urinary albumin excretion in type 2 diabetes. Diabetologia 1999;42 (supplement 1) Abs 865 + poster.
- Freed M et al. Effect of combination therapy with rosiglitazone and Glibenclamide on PAI-1 antigen, PAI-1 activity, and tPA inpatients with type 2 diabetes. Diabetologia 2000;43 (supplement1): A267, Abs 1024 + poster.
- Greenberg A et al. Rosiglitazone reduces c-reactive protein, a marker of systematic inflammation, in type 2 diabetic patients. Diabetologia 2001;44 (supplement1): A222, Abs 853.Prescribing Information
Source: Shire Hall Communications