Early insulin in type 2 diabetes beneficial
Further evidence that early intensive insulin therapy for newly diagnosed type 2 diabetes patients can help the body’s Β-cells recover and restore blood glucose control emerged this week (The Lancet 2008;371:1753).
In a trial of 382 patients in China, aged 25–70 years with type
2 diabetes, participants were randomised to receive a continuous subcutaneous
insulin infusion, multiple daily insulin injections or standard oral
hypoglycaemic medicines. Treatment was stopped after normoglycaemia was
restored for two weeks and patients were followed up on diet and exercise
alone for one year.
The researchers found that 97.1 per cent of patients in the infusion
group achieved normoglycaemia within 4.0 days and 95.2 per cent in the
injection group achieved it within 5.6 days. This compared with 83.5
per cent of patients in the oral hypoglycaemics group achieving normoglycaemia
within 9.3 days.
After one year, more patients in the insulin groups maintained blood
glucose control than in the oral medication group (51.1 per cent and
44.9 per cent versus 26.7 per cent; P=0.0012). The researchers propose
several mechanisms to explain the difference in remission rates, such
as insulin affecting the metabolic memory and impeding the progression
from metabolic abnormalities to irreversible cellular and epigenetic
changes.
“Our findings support the initiation of early transient intensive
insulin treatment in those patients,” they conclude.
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