Intensive Control Inquiry in England

DIABETES HEALTH received the following letter from Advisory Board Member Matthew Kiln, MB, BS, DRCOG, FRSH, from the Paxton Green Health Center in London. The UK Diabetes Adviser wrote in response to “Hypoglycemia: What Every Person Should Know” in the July issue.

I would like to make a couple of comments on the article you had in the July edition concerning hypoglycemia. There was some very interesting and useful information in this article.

However, there is one slightly inaccurate piece of information about the DCCT, which is very relevant to the levels of hypoglycemia that they found when patients were put on intensive diabetes control.

In the DCCT, any patients who had problems with hypoglycemia were excluded from the trial, either before the trial or during the very early stages. Still, a three fold increase in moderate to severe hypoglycemic reactions was found.

In the general diabetic population, a good number of people have significant problems with hypoglycemic attacks. Therefore, their rate of hypoglycemia is likely to be much higher – anything from a four to 10 fold risk is possible.

It is therefore questionable whether it is justified to say that the benefits of intensive control for insulin dependent diabetics outweigh the risks. We do not actually know if this is the case, and we will not know for many, many years.

The point about patients noticing problems after being changed from animal to human insulin needs some further explaining as well. This is not just a few patients mistakenly attributing their problems with hypoglycemia to changing insulins, rather than a change in their level of glycemic control, as one of the people interviewed suggested.

The British Diabetic Association received 2,400 letters from patients and healthcare providers, concerning severe problems when patients were changed from animal to human insulin.

When one looks at this figure it is easy to see that this many reports couldn’t be explained by a confusion over glycemic control changes or insulin species changes. These letters specifically stated that the problems were the result of changing insulin types, and 85 percent reported a significant improvement in hypoglycemic awareness when switched back to animal insulin.

A number of other problems were mentioned in these letters as well. General unwellness, depression and other psychological symptoms were reported. While these symptoms are very difficult to explain, they seem to be very consistent in patients switched to human insulin.

The Insulin Dependent Diabetes Trust in the United Kingdom also has an additional 600 reports from patients experiencing severe problems with human insulin. To say that these are all people who are confused is rather arrogant.

I hope you do not have the same thing happening in America.

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