Diabetes Care, Vol 20, Issue 9 1353-1356, Copyright © 1997 by American Diabetes Association

ARTICLES

Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients by transient intensive insulin treatment

H Ilkova, B Glaser, A Tunckale, N Bagriacik and E Cerasi
Department of Internal Medicine, Istanbul University Cerrahpasa Medical Faculty, Turkey.

OBJECTIVE: Type 2 diabetes is a slowly progressive disease, in which the gradual deterioration of glucose tolerance is associated with the progressive decrease in beta-cell function. Hyperglycemia per se has deleterious effects on both beta-cell function and insulin action, which are partially reversible by the short-term control of blood glucose levels. We hypothesized that the induction of euglycemia, using intensive insulin therapy at the time of clinical diagnosis, could lead to a significant improvement in insulin secretion and action and thus alter the clinical course of the disease. RESEARCH DESIGN AND METHODS: Thirteen newly diagnosed diet-unresponsive type 2 diabetic patients were treated with continuous subcutaneous insulin infusion (CSII) for 2 weeks and followed longitudinally while being treated with diet alone. RESULTS: Four patients were considered therapeutic failures since CSII failed to induce euglycemia (n = 1) or glucose control deteriorated within 6 months after CSII (n = 3). The remaining nine patients were maintained on diet alone with adequate control from 9 to > 50 months (median +/- SE, 26 +/- 4.8 months). In five patients, glycemic control deteriorated after 9-36 months, but a repeat 2-week CSII treatment reestablished control in four patients. One of these patients underwent a third CSII treatment 13 months later. At the time this article was written, six patients of the initial group were still controlled without medication 16-59 months (median +/- SE, 45.5 +/- 6.6 months) after the initiation of treatment. Body weight remained unchanged in all patients. CONCLUSIONS: These findings suggest that in a significant proportion of type 2 diabetic patients who fail to respond to dietary measures, short-term intensive insulin treatment can effectively establish responsiveness, allowing long-term glycemic control without medication. Further studies are required to establish whether simpler treatment regimens could be equally effective. If the hypothesis offered here finds support, present approaches to the management of newly diagnosed type 2 diabetes may need to be revised.
CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				D. M. Nathan, J. B. Buse, M. B. Davidson, E. Ferrannini, R. R. Holman, R. Sherwin, and B. Zinman Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy: A consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes Diabetes Care, January 1, 2009; 32(1): 193 - 203. [Abstract] [Full Text] [PDF]

				M. B. Davidson No Need for the Needle (at First) Diabetes Care, October 1, 2008; 31(10): 2070 - 2071. [Full Text] [PDF]

				M. E. Larkin, V. A. Capasso, C.-L. Chen, E. K. Mahoney, B. Hazard, E. Cagliero, and D. M. Nathan Measuring Psychological Insulin Resistance: Barriers to Insulin Use The Diabetes Educator, May 1, 2008; 34(3): 511 - 517. [Abstract] [Full Text] [PDF]

				M. Massi-Benedetti and M. Orsini-Federici Treatment of Type 2 Diabetes With Combined Therapy: What are the pros and cons? Diabetes Care, February 1, 2008; 31(Supplement_2): S131 - S135. [Abstract] [Full Text] [PDF]

				D. Q. Pham, H. Cohen, and V. Chu Inhaled Human [rDNA Origin] Insulin, a Novel Formulation for Diabetes Mellitus J. Clin. Pharmacol., July 1, 2007; 47(7): 890 - 903. [Abstract] [Full Text] [PDF]

				B. L. Wajchenberg {beta}-Cell Failure in Diabetes and Preservation by Clinical Treatment Endocr. Rev., April 1, 2007; 28(2): 187 - 218. [Abstract] [Full Text] [PDF]

				E. Ferrannini, S. Camastra, A. Gastaldelli, A. Maria Sironi, A. Natali, E. Muscelli, G. Mingrone, and A. Mari Beta-Cell Function in Obesity: Effects of Weight Loss Diabetes, December 1, 2004; 53(suppl_3): S26 - S33. [Abstract] [Full Text] [PDF]

				Y. Li, W. Xu, Z. Liao, B. Yao, X. Chen, Z. Huang, G. Hu, and J. Weng Induction of Long-term Glycemic Control in Newly Diagnosed Type 2 Diabetic Patients Is Associated With Improvement of {beta}-Cell Function Diabetes Care, November 1, 2004; 27(11): 2597 - 2602. [Abstract] [Full Text] [PDF]

				E. A. Ryan, S. Imes, and C. Wallace Short-Term Intensive Insulin Therapy in Newly Diagnosed Type 2 Diabetes Diabetes Care, May 1, 2004; 27(5): 1028 - 1032. [Abstract] [Full Text] [PDF]

				P. Hammond Continuous subcutaneous insulin infusion: short-term benefits apparent, long-term benefits speculative The British Journal of Diabetes & Vascular Disease, March 1, 2004; 4(2): 104 - 108. [Abstract] [PDF]

				P. Raskin, B. W. Bode, J. B. Marks, I. B. Hirsch, R. L. Weinstein, J. B. McGill, G. E. Peterson, S. R. Mudaliar, and R. R. Reinhardt Continuous Subcutaneous Insulin Infusion and Multiple Daily Injection Therapy Are Equally Effective in Type 2 Diabetes: A randomized, parallel-group, 24-week study Diabetes Care, September 1, 2003; 26(9): 2598 - 2603. [Abstract] [Full Text] [PDF]

				S. A. Westphal and P. J. Palumbo Insulin and Oral Hypoglycemic Agents Should Not Be Used in Combination in the Treatment of Type 2 Diabetes Arch Intern Med, August 11, 2003; 163(15): 1783 - 1785. [Full Text] [PDF]

				D. M. Nathan Initial Management of Glycemia in Type 2 Diabetes Mellitus N. Engl. J. Med., October 24, 2002; 347(17): 1342 - 1349. [Full Text] [PDF]

				S. Park and S. B. Choi Effects of {alpha}-tocopherol supplementation and continuous subcutaneous insulin infusion on oxidative stress in Korean patients with type 2 diabetes Am. J. Clinical Nutrition, April 1, 2002; 75(4): 728 - 733. [Abstract] [Full Text] [PDF]

				M. J. Lenhard and G. D. Reeves Continuous Subcutaneous Insulin Infusion: A Comprehensive Review of Insulin Pump Therapy Arch Intern Med, October 22, 2001; 161(19): 2293 - 2300. [Abstract] [Full Text] [PDF]

				D. M. Nathan Inhaled Insulin for Type 2 Diabetes: Solution or Distraction? Ann Intern Med, February 6, 2001; 134(3): 242 - 244. [Full Text] [PDF]

				R. A. DeFronzo Pharmacologic Therapy for Type 2 Diabetes Mellitus Ann Intern Med, August 17, 1999; 131(4): 281 - 303. [Abstract] [Full Text] [PDF]