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Beneficial effects of insulin in new onset type 2 diabetes with severe hyperglycemia
Posted by
Thomas Repas, DO, FACP, FACE, CDE
November 7, 2008 08:51 AM
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Insulin
therapy in patients with newly diagnosed type 2 diabetes may have benefits
beyond improved glycemic control. Several studies have suggested that early
insulin therapy may improve beta-cell function. Many of us have observed this
in clinical practice.
In the October 2008 issue of Diabetes Care, Chen et al
reported the results of a study comparing the effects of insulin to oral
antidiabetic agents on new onset type 2 diabetes with severe hyperglycemia
(fasting plasma glucose ≥300 mg/dL or random plasma glucose ≥400 mg/dL).
The individuals were treated as inpatients with intensive insulin therapy for
10 to 14 days. After hospitalization, 50 patients were randomly assigned to
either twice a day neutral protamine hagedorn insulin or oral antidiabetic
drugs (metformin or sulfonylurea). An oral glucose tolerance test was obtained
immediately after hospitalization and at six months. Long term glycemic
control, beta-cell function and insulin sensitivity were also evaluated.
The dose of insulin decreased over the course of the study whereas the
dose of oral agents increased. At the end of the six months, the HbA1C was
significantly lower in the insulin group than in the oral medication group:
6.78% vs. 7.84% (P=.009). Beta-cell function as measured by oral glucose
tolerance testing was improved in both groups but significantly improved in the
insulin-treated group compared to the oral medication group. There was no
significant difference in the rate of hypoglycemia between groups.
These results are consistent with what I have witnessed in my own
practice. I am curious about what the effects of newer antidiabetic medications
or a more intensive insulin regimen might have been.
A recent
consensus statement on the management of type 2 diabetes released by the
American Diabetes Association and European Association for the Study of
Diabetes recommended earlier use of insulin, after patients failed therapeutic
lifestyle modification and metformin. Although this makes sense in regards to
improved glycemic control, it will be challenging to convince our patients of
that.
Too many arrive to my office after years and years of uncontrolled
diabetes before they finally agree to advance to insulin.
Diabetes Care. 2008;31:1927-1932.
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