Early intensive insulin therapy in patients with newly diagnosed type 2 diabetes can help the body's insulin-producing β-cells recover and restore blood glucose control. These are the conclusions of authors of an Article in this week's Diabetes Special Issue of The Lancet.
Previous studies have suggested such intensive therapy could change or delay the natural course of type 2 diabetes. Professor Jianping Weng, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China, and colleagues did a randomised controlled trial of 382 patients aged 25-70 years from nine centres in China, all with type 2 diabetes. Patients were randomised to one of three groups. Of these, two were types of intensive insulin therapy, either continuous subcutaneous insulin infusion (CSII) (137 patients), or multiple daily insulin injections (MDI) (124 patients). The third group (121 patients), received standard oral diabetic drugs. Treatment was stopped after regular blood glucose control (normoglycaemia) was restored for two weeks. Patients were then followed up on diet and exercise alone. Intravenous glucose tolerance tests were done and blood glucose, insulin, and proinsulin* measured before and after therapy withdrawal and at 1-year follow-up.
The researchers found more patients achieved target blood glucose control in the two insulin groups and in a shorter time than the group on oral drugs. In the CSII group, 97% achieved normoglycaemia within four days; in the MDI group, 95% achieved normoglycaemia within 5.6 days; these compared with 83.5% in the oral drugs group achieving normoglycaemia within 9.3 days. Remission rates – ie, maintenance of this blood sugar control, were higher after one year in both insulin groups (CSII 51%, MDI 45%), than in the oral drugs group (27%). β-cell function was improved significantly in the insulin groups.
The authors conclude: "Early intensive insulin therapy in patients with newly diagnosed type 2 diabetes has favourable outcomes on recovery and maintenance of β-cell function and prolonged glycaemic remission compared with treatment with oral hypoglycaemic agents."
In an accompanying Comment, Dr Ravi Retnakaran and Dr Daniel J Drucker, Division of Endocrinology, University of Toronto, Canada, say: "Although the relevant biological mechanisms and target tissues contributing to preferential improvement in β-cell function remain unclear, these data suggest that use of intensive insulin therapy early in the course of type 2 diabetes warrants further clinical investigation."
Notes to editors: *proinsulin is a molecular precursor of insulin, which is eventually processed by the body into mature insulin
Professor Jianping Weng, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China T) +862085253162 E) wjianp@mail.sysu.edu.cn
Dr Daniel J Drucker, Banting and Best Diabetes Centre, and Division of Endocrinology, University of Toronto contact by e-mail only d.drucker@utoronto.ca
http://multimedia.thelancet.com/pdf/press/insulintherapy.pdf
Journal
The Lancet