The ORIGIN study addressed in over 12,000 subjects (>85% with new or previously diagnosed type 2 diabetes) using a 2x2 factorial design the effects of n-3 fatty acid supplements and titrated basal insulin glargine on firstly cardiovascular outcomes and secondly the development of diabetes.  The trial initially designed to last for 4 years was extended by at least 2 years. 

The major findings were in the glargine insulin arm which revealed a neutral effect on cardiovascular outcomes.  Furthermore, there was a modest effect in reducing new onset diabetes although as predicted this was associated with increased hypoglycaemia (~ 3fold) and weight gain of >1.5 kg.  The major finding was no evidence of increased cancer or death from cancer with insulin glargine.

These findings confirm the safety of insulin therapy and suggest that the putative proatherosclerotic and mitogenic effects of exogenous insulin do not  translate to increased cardiovascular disease or malignancy.