The ORIGIN trial could not document CV benefits from early insulin treatment in high-risk patients with recent-onset diabetes while it increases severe and nonsevere hypoglycemia . On the other hand, one could read the trial’s results to conclude that insulin treatment in high-risk CV patients is not associated with increased CV or neoplastic event rate. Given prior concern associated with insulin use, this may be seen as a reassuring finding.
Insulin glargine also slowed progression from prediabetes to diabetes, but cost-effectiveness doubts remain. Therefore, it is unlikely that ORIGIN strategy will significantly impact current management of diabetes. Moreover, the results of the ORIGIN trial are not going to put a final word on the long-debated question about the best time to initiate insulin treatment and whether maintenance of good glycemic control may convey any CV advantage.…
