Endocrine Abstracts

Introduction

Traditionally, there has been a stepwise introduction of glucose-lowering interventions, with the final ’step’ of insulin therapy being administered 10–15 years after diagnosis. Both patients and physicians are often reluctant to start insulin because of fears of painful injections, hypoglycemia, and weight gain. The aim of our study was to assess the effectiveness of initial basal insulin therapy on glycaemic control in type 2 diabetic patients and to study the effects of this treatment on body weight.

Methods

We conducted a retrospective study including patients with type 2 diabetes previously on oral agents, followed up in our department 6 months after initiating insulin therapy.

Results

97 patients were included with a mean age of 59 ± 9.5 years. More than half of patients were women (61%). The duration of diabetes was meanly 9.5 ± 6.2 years. The mean glycated hemoglobin (HbA1c) before starting insulin therapy was 10.8% ± 2.2. Six months after initiating insulin, the mean HbA1c was 9.2% ± 1.6 and the mean weight gain was 4.2 kg ± 4.9. The majority (89%) were taking metformin in association with insulin. Higher doses of insulin therapy were associated with a greater weight gain and a better glycemic control with a significant P = 0.01. Weight gain was significantly smaller when metformin was associated to initial insulin therapy (P = 0.02).

Conclusion

Insulin therapy is associated with both a better glycemic control and a greater weight gain. Use of metformin in combination with insulin is commonly recommended as a way to limit weight gain in patients with type 2 diabetes. For lasting weight control, lifestyle interventions need to continue throughout the course of treatment.