The effect of early insulin therapy on pancreatic β-cell function and long-term glycemic control in newly diagnosed type 2 diabetic patients.
OBJECTIVE
Based on the results of well designed clinical studies, intensive insulin therapy has been established to improve glycemic control in newly diagnosed diabetes. However, discrepancies exist between the findings of clinical trials and experiences in general practice. Furthermore, the efficacy of an early insulin therapy (EIT) - commonly used in general practice - on long-term glycemic control has not been established. Therefore, we evaluated the effects of EIT on pancreatic β-cell function and glycemic control using insulin-based methods widely employed in general practice.


METHODS
We performed a retrospective cohort study that initially involved reviewing patients' medical records. Following a thorough review, 61 patients who received either biphasic or prandial EIT at the time of diagnosis were enrolled. We then evaluated changes in β-cell function and glycemic control during a 48-month follow-up period.


RESULTS
Mean HbA1c decreased significantly as a result of EIT from 10.7 ± 1.8% to 6.2 ± 1.1% (p < 0.001). On average, 2.6 months was required to achieve an HbA1c value < 7%. EIT significantly improved the insulinogenic index. Glycemic control was well maintained for 48 months. More than 70% of patients were able to maintain glycemic control following lifestyle modifications or treatment with oral antidiabetic drugs. No significant differences were identified between patients receiving biphasic EIT and prandial EIT in terms of glycemic control or pancreatic β-cell function.


CONCLUSIONS
Our results suggest that regardless of the method of delivery, EIT significantly improves β-cell function and facilitates long-term glycemic control in patients with newly diagnosed type 2 diabetes mellitus.
Chon
Suk
S
Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea.
Oh
Seungjoon
S
Kim
Sung Woon
SW
Kim
Jin-Woo
JW
Kim
Young Seol
YS
Woo
Jeong-taek
JT
D000284:Administration, Oral; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007333:Insulin Resistance; D050417:Insulin-Secreting Cells / Q000187:drug effects* / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human