ORIGIN TRIAL: Does Use of Basal Insulin to Maintain Glycemic Control Improve CV Outcomes?

The "Outcome Reduction with an Initial Glargine Intervention" (ORIGIN) study, published on June 11 in The New England Journal of Medicine (NEJM), tests the hypothesis that providing sufficient basal insulin to normalize fasting plasma glucose levels may reduce adverse cardiovascular outcomes – a hypothesis that until now has not been formally tested.

The study looked at 12,537 patients averaging 63 years of age who had cardiovascular risk factors and impaired fasting glucose, impaired glucose tolerance or type 2 diabetes, and administered insulin glargine or standard care and n-3 fatty acids or placebo with the use of a 2 x 2 factorial design.

Overall outcomes showed that insulin glargine had a neutral effect on cardiovascular outcomes and cancers when used to target normal fasting glucose levels for more than six years, as compared with guideline-suggested glycemic control. The study also found that while this therapy maintained near-normal glycemic control and slowed progression of dysglycemia, it was also associated with modest increases in hypoglycemic episodes and weight gain.

The study authors noted, that "whether the glycemic benefit will affect future microvascular or other outcomes remains unknown." However, in the meantime, they suggest that the study findings do not support changing standard therapies for early dysglycemia.

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