Thanks again all,
I think this is one of the most productive discussions I've had about insulin (forget most doctors!).
Denise, thanks very much for identifying the link to the paper we are discussing, and also for the links to the two guideline documents. Regarding HBA1C and type 2s, one question is whether we actually know what BG levels are in the 'normal' population, the NICE guidelines (for Types 1 and 2) cite frequently quoted figures, but not any research citation supporting these. Your options 1-5 all look to me like plausible reasons why people might not attain ideal targets (whatever those may be), I'm not sure about 'non-compliance' , I've always found this a rather derogatory term, since it implies, for example, that the medics giving the advice are definately right in some objective sense, and I feel this is in practice unlikely to be true, also, a study on some of the oldest living type 1 diabetics found that one of the main factors which made them stand out from diabetics who had pre-deceased them was that they were 'non-compliant' with medication... (sorry, again I don't have a link, I can dig out the reference if you're interested, it is a study comparing the US diabetic 'gold medallists' with diabetics who died younger having similar general profiles) given the study we are discussing here maybe there's a reason for that! I'm not sure about the joining a forum option, I think its 'horses for courses', I have found this discussion has turned up a lot of stuff I didn't know about and which looks like it could be quite important, but in the main I find that the threads are more about looking for/providing emotional support (which is fine of course!!) so I think in terms of the value of a forum it just depends what you are looking for, rather than about necessarily finding an evidence base or some concrete and objectively valid advice. .
Elaine77, regarding your query: the average weight at baseline for the sample was given as follows: Males: 93.8kg females; 82.2 kg. I'm not sure how this compares with the general population and the table suggests that this is an average which measures some people more than once (the details focus on weight at 'glucose relevant exposure periods' (N=105,123) rather than people (N=84,622) as such.
Smidge: Thank you again for some novel insights. I had never heard of the C-peptide issue either. I would really appreciate any of the papers you are able to track down with reference to the mode/mechanism of action of exogenous vs natural insulin. Really interesting.
Brett: Likewise, thank you for the novel insights. I had suspected that fat distribution became a little odd with insulin, but had not heard that referred to before as any kind of accepted fact.
Much 'food' for thought!