Insulin associated with greater glycemic control, beta-cell function than oral antidiabetes agents

Insulin yielded greater short-term improvements in glycemic control and beta-cell function compared with oral antidiabetes agents in patients with newly diagnosed type 2 diabetes with severe hyperglycemia.

Researchers from Taiwan compared the two therapies in 50 patients with newly diagnosed diabetes and severe hyperglycemia; 30 were randomly assigned to receive insulin therapy and 20 to oral antidiabetes agents.

All patients were treated with in-hospital intensive insulin injections for 10 to 14 days, after which each was randomly assigned to a treatment. An oral glucose tolerance test and evaluation of insulin sensitivity and beta-cell function were performed after intensive insulin treatment and again six months later.

“Desired glycemic control was successfully achieved by intensive insulin therapy for 10 to 14 days. However, most of these subjects required pharmacological therapy to maintain near-euglycemia in our study period,” the researchers wrote.

At six months, patients using insulin experienced significantly lower HbA1c levels compared with patients using oral antidiabetes agents (6.33% vs. 7.5%; P=.002). After six additional months of follow-up, the insulin group continued to have higher HbA1c levels (6.78% vs. 7.84%; P=.009).

Additionally, beta-cell function was significantly improved in both groups after six months of treatment. However, patients assigned to insulin experienced a better beta-cell function index, insulin area under the curve and insulinogenic index compared with patients assigned to oral antidiabetes agents. – by Katie Kalvaitis

Diabetes Care. 2008;31:1927-1932.

The authors make the fascinating assertion that a course of intensive insulin treatment early in the course of type 2 diabetes will have long-lasting benefit in improving its metabolic control. Although there may be some methodologic flaws (the oral agent treatment arm may not have been maximized according to the stated protocol), this appears to be an important therapeutic approach which has the potential of changing the natural history of the disease. A similar, somewhat larger study was recently reported by Weng et al in The Lancet.

– Zachary T. Bloomgarden, MD

Endocrine Today Editorial Board member