The outcome of Beta cell function after early insulin therapy in the recently diagnosed type 2 diabetes (in Egyptian population) our experience in EL-Minia university hospital
Y. Mousa, A. Mohamed & M. Kamel
The purpose of this prospective cohort study was to evaluate whether early insulin therapy is more advantageous in achieving long-term optimal glycemic control with improved B cell function than oral drugs in the recently diagnosed type 2 diabetes mellitus. Methods: Sixty consecutive patients with recently diagnosed type 2 diabetes mellitus were divided into 3 groups.The 1st group received 2 SC injections of premixed insulin. The 2nd group received bed time NPH and 3 injections of regular insulin before meals. The 3rd group received metformin and/or sulphonylureas. The treatment continued for 3 months till euglycemia was reached. Then, all medications were stopped and the patients were followed up till the end of the year. BMI, FBG, PPG, HbA1C, fasting level of insulin, proinsulin, C-peptide, HOMA-IR, HOMA-B, serum cholesterol, triglycerides were estimated. Results: Six patients from group I (30%), nine from group II (45%), and only one from group III (5%) succeeded to maintain euglycemia without further therapy for 9 months after stoppage of treatment. The mean HbA1C level was 6.5% in group I, 6.1% in group-2, and >7% in the group-3. Level of HbA1C in the succeeded patients declined significantly in comparison to the failed patients. Markers of β-cell function of the succeeded patients showed a statistical significant increase regarding the C-peptide, insulin and HOMA-B. Meanwhile, proinsulin level and proinsulin / insulin ratio declined (P=0.0001). The total serum cholesterol and triglycerides of insulin treated groups reduced significantly (P=0.001). Conclusions: Short-term insulin therapy in a newly diagnosed type 2 diabetes naive patients can preserve β-cell function and insulin secretion, allowing long-term glycemic control without medication and may improve glycemic responses to supplemental oral treatment if needed.
Keywords: Type 2 DM, early insulin therapy, B cell function
Abbreviations: BMI: Body mass index, FBG: fasting blood glucose; PPG: postprandial glucose, HbA1C: Glycosylated haemoglobin, OADs: oral antidiabetic drugs; HOMA-B: homeostasis model assessment of B-cell function; HOMA-IR: homeostasis model assessment of insulin resistance.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.