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Short-term intensified insulin treatment in type 2 diabetes: long-term effects on β-cell function
1Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada.
Abstract:
The natural history of type 2 diabetes (T2DM) is characterized by progressive deterioration of pancreatic β-cell function, leading to worsening glycemia over time. As current antidiabetic therapies have not yet been shown to profoundly alter this natural history, many patients ultimately will require exogenous insulin therapy to obtain adequate glycemic control. Interestingly, the temporary use of short-term intensive insulin therapy early in the course of T2DM has recently emerged as a therapeutic option that may offer favourable long-term effects on β-cell function. Indeed, after receiving this treatment, many patients will experience sustained euglycemia without requiring any antidiabetic therapy. This apparent 'remission' of diabetes is likely secondary to improved β-cell function and can last for more than a year, although it is not sustained and hyperglycemia eventually will return. Nevertheless, owing to its effects on β-cell function, short-term intensive insulin therapy holds promise as a means for modifying the natural history of T2DM and warrants further study in this context. In this report, we will review the rationale and evidence underlying this interesting therapeutic option, and its implications for both clinical research and the management of patients with T2DM.
Insights
Short-term intensive insulin therapy may improve pancreatic beta-cell function in type 2 diabetes (T2DM), potentially leading to a temporary remission of the disease and improved glycemic control.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Diabetes Research
Background:
- Type 2 diabetes (T2DM) is marked by progressive decline in pancreatic beta-cell function and worsening glycemic control.
- Existing therapies often fail to alter the natural progression of T2DM, frequently necessitating insulin treatment.
Purpose of the Study:
- To review the rationale and evidence for short-term intensive insulin therapy (IIT) in T2DM.
- To explore the potential of IIT to modify the natural history of T2DM and improve beta-cell function.
Main Methods:
- Review of existing literature on short-term IIT in T2DM.
- Analysis of studies investigating the long-term effects of early IIT on beta-cell function and glycemic control.
Main Results:
- Early short-term IIT can lead to sustained euglycemia and apparent diabetes remission in many T2DM patients.
- This remission, attributed to improved beta-cell function, can last over a year but is not permanent.
- Hyperglycemia eventually returns, indicating the remission is not sustained indefinitely.
Conclusions:
- Short-term IIT shows promise in modifying the natural history of T2DM by enhancing beta-cell function.
- Further research is warranted to understand and optimize this therapeutic approach for T2DM management.
- IIT may offer a valuable strategy for improving long-term outcomes in patients with type 2 diabetes.
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