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Early insulin in type 2 diabetes beneficial

Further evidence that early intensive insulin therapy for newly diagnosed type 2 diabetes patients can help the body’s ß-cells recover and restore blood glucose control emerged in May 2008 (The Lancet 2008;371:1753).

In a trial of 382 patients in China, aged 25–70 years with type 2 diabetes, participants were randomised to receive a continuous subcutaneous insulin infusion, multiple daily insulin injections or standard oral hypoglycaemic medicines. Treatment was stopped after normoglycaemia was restored for two weeks and patients were followed up on diet and exercise alone for one year.

The researchers found that 97.1 per cent of patients in the infusion group achieved normoglycaemia within 4.0 days and 95.2 per cent in the injection group achieved it within 5.6 days. This compared with 83.5 per cent of patients in the oral hypoglycaemics group achieving normoglycaemia within 9.3 days.

After one year, more patients in the insulin groups maintained blood glucose control than in the oral medication group (51.1 per cent and 44.9 per cent versus 26.7 per cent; P=0.0012).

The researchers propose several mechanisms to explain the difference in remission rates, such as insulin affecting the metabolic memory and impeding the progression from metabolic abnormalities to irreversible cellular and epigenetic changes.

“Our findings support the initiation of early transient intensive insulin treatment in those patients,” they conclude.

Citation: The Pharmaceutical Journal URI: 10025533

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