Related Experiment Videos
Short-term intensive insulin therapy in newly diagnosed type 2 diabetes
Edmond A Ryan1, Sharleen Imes, Clarissa Wallace
1Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. edmond.ryan@ualberta.ca
Objective:
Type 2 diabetes is associated with defects in insulin secretion and insulin action. Hyperglycemia may aggravate these defects, a feature known as glucose toxicity. Previous studies have shown that acute correction of hyperglycemia in subjects with long-standing type 2 diabetes gives only short-term improvement in glycemic control after discontinuation of insulin. The current study attempts to identify any characteristics of patients with newly diagnosed type 2 diabetes (fasting glucose >11.0 mmol/l) who would have a long-term benefit, in terms of glycemic control, from a brief course of insulin therapy.
Research Design And Methods:
A total of 16 subjects (52 +/- 2 years old [range 36-64], BMI 30.8 +/- 1.9 kg/m2) with newly diagnosed type 2 diabetes had a 2-3 week course of intensive insulin therapy that was then discontinued.
Results:
Fasting glucose fell from 13.3 +/- 0.7 to 7.0 +/- 0.4 mmol/l, and this improvement was maintained at the 1-year follow-up (6.7 +/- 0.3 mmol/l). The insulin area under the curve for the posttreatment oral glucose tolerance test also improved (8,251 +/- 1,880 before therapy, 18,404 +/- 4,040 directly after insulin therapy, and 42,368 +/- 8,517 pmol.min at the 1-year follow-up). At 1 year, seven of the subjects maintained good glycemic control on diet therapy alone, eight required oral hypoglycemic agent (OHA) therapy, and one required insulin therapy. The distinguishing features of those who did not require OHA or insulin therapy were that they required less insulin during the active insulin therapy phase (0.37 +/- 0.05 vs. 0.73 +/- 0.07 units.kg(-1).day(-1)) and were able to attain a lower fasting serum glucose at the end of the period of insulin therapy (5.9 +/- 0.3 vs. 7.7 +/- 0.4 mmol/l).
Conclusions:
These results demonstrate that in newly diagnosed type 2 diabetes with elevated fasting glucose levels, a 2- to 3-week course of intensive insulin therapy can successfully lay a foundation for prolonged good glycemic control. The ease with which normoglycemia is achieved on insulin may predict those patients who can later succeed in controlling glucose levels with attention to diet alone.
Insights
Newly diagnosed type 2 diabetes patients benefit long-term from brief insulin therapy. Lower insulin needs and better glucose control during treatment predict sustained glycemic control with diet alone.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Diabetes Research
Background:
- Type 2 diabetes involves insulin secretion and action defects, exacerbated by hyperglycemia (glucose toxicity).
- Previous studies show limited long-term glycemic control improvement after acute insulin therapy in long-standing type 2 diabetes.
Purpose of the Study:
- Identify characteristics of newly diagnosed type 2 diabetes patients who achieve long-term glycemic control benefits from brief insulin therapy.
- Investigate predictors of sustained glycemic control post-intensive insulin treatment.
Main Methods:
- 16 subjects with newly diagnosed type 2 diabetes (fasting glucose >11.0 mmol/l) received 2-3 weeks of intensive insulin therapy.
- Glycemic control and insulin needs were assessed before, during, and at 1-year follow-up after insulin discontinuation.
Main Results:
- Fasting glucose significantly improved and was maintained at 1 year (13.3 to 6.7 +/- 0.3 mmol/l).
- Insulin secretion (area under the curve) improved substantially by the 1-year follow-up.
- Patients requiring less insulin (0.37 units.kg(-1).day(-1)) and achieving lower fasting glucose (5.9 mmol/l) during therapy were more likely to maintain glycemic control with diet alone.
Conclusions:
- A short intensive insulin therapy course can establish a foundation for prolonged glycemic control in new-onset type 2 diabetes.
- Achieving normoglycemia easily during insulin treatment may predict successful long-term glycemic management with diet alone.
Related Concept Videos
01:16Insulin: Dosing Regimen and Adverse Effects
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
01:26Type II Diabetes I: Introduction
01:22Diabetes Mellitus: Overview and Type I Subtype
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
01:27Insulin Formulations: Types and Delivery
Short-acting insulins are divided into rapid-acting...
01:12Type I Diabetes I: Introduction
01:22Diabetes Mellitus: Type 2 and Gestational