Beneficial Effects of Insulin on Glycemic Control and β-Cell Function in Newly Diagnosed Type 2 Diabetes With Severe Hyperglycemia After Short-Term Intensive Insulin Therapy

Abstract

OBJECTIVE -To evaluate whether treatment with insulin is advantageous compared with oral antidiabetes agents in newly diagnosed type 2 diabetes with severe hyperglycemia after short-term intensive insulin therapy.RESEARCH DESIGN AND METHODS -Newly diagnosed type 2 diabetic patients with severe hyperglycemia were hospitalized and treated with intensive insulin injections for 10 -14 days. The oral glucose tolerance test (OGTT) was performed after intensive insulin treatment. After discharge, the patients were randomized to receive either insulin injections or oral antidiabetes drugs (OADs) for further management. The OGTT was repeated 6 months later, and ␤-cell function and insulin sensitivity were evaluated again. These subjects were continually followed up for another 6 months to evaluate their long-term glycemic control.RESULTS -At the 6th month of the study, the A1C level was significantly lower in the insulin group than in the OAD group (6.33 Ϯ 0.70% vs. 7.50 Ϯ 1.50%; P ϭ 0.002). During the follow-up visit, the A1C level was still better in the insulin group (6.78 Ϯ 1.21% vs. 7.84 Ϯ 1.74%; P ϭ 0.009). All parameters regarding ␤-cell function measured in the OGTT were improved significantly in both groups after 6 months of treatment. Compared with the OAD group, the homeostasis model assessment of ␤-cell function index, insulin area under the curve, and insulinogenic index were better in the insulin group. CONCLUSIONS -A 6-month course of insulin therapy, compared with OAD treatment, could more effectively achieve adequate glycemic control and significant improvement of ␤-cell function in new-onset type 2 diabetic patients with severe hyperglycemia.

Short duration of diabetes and disuse of sulfonylurea have any association with insulin cessation of the patients with type 2 diabetes in a clinical setting in Japan (JDDM 30)

“…Intensive insulin therapy, such as multiple insulin injections or continuous subcutaneous insulin infusion, has been reported to be effective for near-normoglycemic remission in newly diagnosed T2DM patients [5,6]. However, the frequency of daily insulin injections had no significant association with the cessation of insulin therapy in the present study.…”

“…However, we did not have data of CPR in all subjects and it has not been elucidated whether these markers become predictors of the cessation of insulin therapy. Conversely, it has been reported that β-cell function in newly diagnosed T2DM patients recovers following intensive insulin therapy [5,6]. These observations suggest that remission may occur more commonly in patients with a shorter duration of diabetes because β-cell function in these patients has the potential to recover.…”

“…Some studies have demonstrated that early intensive insulin therapy for a short time in patients with newly diagnosed T2DM may achieve near-normoglycemic remission [5,6]. These studies suggest that elimination of glucotoxicity by intensive insulin therapy may improve β-cell function and achieve remission [5,6]. Conversely, sulfonylureas may exert negative effects on β-cells by overstimulation and the induction of desensitization, which is known as "secondary failure" [7,8].…”

“…Some studies have demonstrated that early intensive insulin therapy for a short time in patients with newly diagnosed T2DM may achieve near-normoglycemic remission [5,6]. These studies suggest that elimination of glucotoxicity by intensive insulin therapy may improve β-cell function and achieve remission [5,6].…”

Targeting beta-cell preservation in the management of type 2 diabetes

“…3,118 The effect of short-term IIT early in T2D was to improve betacell function (first-phase insulin response, HOMA-B and proinsulin:insulin ratio). 3,117,119 Restoration of first-phase insulin secretion predicted maintenance of euglycaemia at one year. 3 What were the characteristics of the responders to IIT?…”