Early Intensified Insulin Therapy in Newly Diagnosed Type 2 Diabetes Leads to Sustained Improvement in Glycemic...

Type 2 diabetes (T2D) is a progressive disease characterized by relentless deterioration of pancreatic β-cell function. Traditionally, insulin is used in later stages of T2DM. This study looks at use of insulin at time of diagnosis of T2DM and its effect on glycemic control and beta cell function.

This is a prospective observational study conducted in symptomatic newly diagnosed type 2 diabetes adults (>18 years) who presented with glycated hemoglobin (A1C) levels > 9%. For the initial 8 weeks, patients were treated with pre-mix insulin after which they were changed over to oral agents, and followed up for next three years.

Amongst 122 study participants, who completed the study, 50% were female and 90% were from rural areas. Average age of participants was 51.4 ± 9.6 years. Baseline mean fasting plasma glucose (FPG), post prandial plasma glucose (PPPG) and A1C were 267 ± 76 mg/dl, 408 ± 101 mg/dl and 11.5 ± 1.4% respectively. At the end of insulin therapy (8 weeks), the mean FPG, PPG and A1C reduced to 107 ± 10 mg/dl, 145 ± 24 mg/dl and 7.3 ± 0.8% respectively all of which were highly significant. The mean post-prandial C-peptide significantly increased from 1.8± 0.6 to 2.8± 0.9 ng/dl. An average of 1.7 kg weight gain and 0.97 episodes of mild to moderate hypoglycemia were observed. At the end of study (156 weeks), the mean FPG, PPG and A1C were 99 ± 14 mg/dl, 152 ± 12 mg/dl and 6.7 ± 0.4%.

Early insulin therapy in treatment naïve patients with type 2 diabetes results in rapid improvement of glycaemia thus helps to maintain long term normoglycemia and improves β-cell function.