The author of the opinion piece linked to says this about the UKPDS trial, "3,867 people with newly diagnosed type 2 diabetes were randomized to either
intensive blood sugar control with insulin, aiming at a fasting blood sugar of less than 6 mmol/l " whereas the original paper says, "3867 newly diagnosed patients with type 2 diabetes, median age 54 years (IQR 48-60 years), who after 3 months' diet treatment had a mean of two fasting plasma glucose (FPG) concentrations of 6.1-15.0 mmol/L were randomly assigned
intensive policy with a sulphonylurea (chlorpropamide, glibenclamide, or. glipizide) or with insulin, or conventional policy with diet. The aim in the intensive group was FPG less than 6 mmol/L." In other words, he is claiming that all of the intensive treatment was with insulin whereas it was either with a sulphonylurea or with insulin.
https://www.researchgate.net/public...ons_in_patients_with_type_2_diabetes_UKPDS_33
He also doesn't seem to understand the natural history of retinopathy. He says, "It’s also worth noting here that most of the 3% reduction in microvascular disease was actually a reduction in probability of getting laser therapy to the retina, i.e. was not connected with any noticeable symptoms but rather with a treatment that was given based on opthalmoscopic findings (people with diabetes regularly have opthalmoscopic examinations of their retinas to look for signs of disease progression)." One of the difficulties with retinopathy is that people don't get symptoms until very late on in the disease - the damage has already been done. If people require laser treatment to prevent sight loss, then that is clinically significant. The percentages may seem small but when you scale up for the huge number of people with diabetes in this country, that is a lot of people who may have be able to avoid sight-loss.
The author also says, "Note also that the study wasn’t blinded, so it’s not beyond the scope of possibility to think that the researchers might have influenced events in such a way that the insulin treated participants got less laser therapy than the control group, in order to improve their stats. " However, in the original paper it says, "The clinical decision for photocoagulation or cataract extraction was made by ophthalmologists independent of the trial."
The opinion piece doesn't address the way that insulin is used in people with type 2 diabetes in later stages of the disease when natural insulin production has dropped.
