Endocrine Abstracts (2011) 26 MTE7

When to instigate insulin therapy in DM2

Jan Skrha

University of Prague, Prague, Czech Republic.

The main pathophysiological feature of type 2 diabetes mellitus is based on combination of impaired β-cell insulin secretion and insulin action in peripheral tissues. However, as progressive loss of the β-cells developes as a consequence of apoptosis, the insulin supply is later necessary. This picture is completely different in type 1 diabetes when insulin insufficiency is developed early in the disease and exogenous insulin is exagerated to maintain metabolic homeostasis and patient’s life as well.

The key question can be postulated: what is the proper time for insulin treatment in type 2 diabetic patient? The replies are different between specialists and frequently depend on their experience with the treatment of type 2 diabetic patients. It could be therefore important if there would exist any ‘evidence based’ data supporting the needs for insulin treatment in earlier or later time during the disease. Insulin role in the β-cell apoptosis has been evaluated with a conclusion that there is some evidence on β-cell protection due to insulin administration. From this point of view, this early insulin instigation would be appropriate. The problem will come when significant insulin resistance is developed, typically in obese individuals. Then higher doses of insulin administered may be deleterious for worsening of resistance and further of diabetes control. In those diabetic patients (with increasing obesity) may be used the insulin treatment in much more later stage than in the lean individuals.

Positive and negative influences of early insulin treatment in Type 2 diabetic patients are discussed in the light of individual selected patients for the appropriate therapy. It may be admitted that no single recommendation for each type 2 diabetic patient to introduce early insulin administration can be suggested because of heterogeneity in this population with diabetes.

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