Early insulin therapy may be beneficial in type 2 diabetes

Early intensive insulin therapy in patients with newly diagnosed type 2 diabetes might improve beta-cell function and result in extended glycaemic remissions, reported a recent study published in The Lancet. Researchers performed a multicentre, randomised trial to compare the effects of transient intensive insulin therapy with oral hypoglycaemic agents on beta-cell function and diabetes remission rate.

This study enrolled 382 patients, aged 25 to 70 years from 9 centres in China between September 2004 and October 2006. The patients, with fasting plasma glucose of 7.0 to 16.7 mmol/L, were randomly assigned to therapy with insulin or oral hypoglycaemic agents for initial rapid correction of hyperglycaemia. Treatment was stopped after normoglycaemia was maintained for two weeks. Patients were then followed up on diet and exercise alone. Intravenous glucose tolerance tests were performed and blood glucose, insulin, and proinsulin were measured before and after therapy withdrawal and at 1-year follow-up. The primary endpoint was time of glycaemic remission and remission rate at 1 year after short-term intensive therapy.

More patients achieved target glycaemic control in the insulin groups than those treated with oral hypoglycaemic agents. Also, remission rates after 1 year were signi?cantly higher in the insulin groups than in the oral hypoglycaemic agents group. Beta-cell function and acute insulin response improved signi?cantly after intensive interventions. The increase in acute insulin response was sustained in the insulin groups but signi?cantly declined in the oral hypoglycaemic agents group at 1 year in all patients in the remission group.

These results demonstrated that excellent glycaemic control could be successfully achieved in 7.9 days in most patients with mean fasting plasma glucose of 11.2 mmol/L, irrespective of insulin use, or oral hypoglycaemic intervention.

Researchers concluded that early intensive insulin interventions in patients with newly diagnosed type 2 diabetes improve recovery and maintenance of beta-cell function and prolonged glycaemic remission. These favourable outcomes were observed when compared with treatment of oral hypoglycaemic agents. These ?ndings support the initiation of early transient intensive insulin treatment in those patients.