Endocrine Abstracts

Background: Worsening hyperglycemia in type 2 diabetes may be due to continuous decline in insulin secretion secondary to β-cell dysfunction and decreased insulin sensitivity. 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, HbA_1C, 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 HbA_1C level was 6.5% in group I, 6.1% in group-2, and >7% in the group-3. Level of HbA_1C 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, HbA_1C: Glycosylated haemoglobin, OADs: oral antidiabetic drugs, HOMA-B: homeostasis model assessment of ß-cell function, HOMA-IR: homeostasis model assessment of insulin resistance.