Insulin as First Therapy for Type 2 Diabetes: Study

Dr. Ildiko Lingvay from the University of Texas Southwestern Medical Center at Dallas said,"Insulin has traditionally been viewed as a treatment of last resort because of an undesirable effect on patient quality of life and decreased treatment satisfaction leading to poor compliance.… Our study busts the myths surrounding insulin therapy in Type 2 diabetes."  

For a 3-month lead-in period, treatment-naive patients diagnosed with Type 2 diabetes within the previous 2 months were managed with insulin and metformin. Then, for the 3-year study, patients were randomized to continue insulin and metformin or switch to metformin, pioglitazone, and glyburide, with 29 patients in each group. 

As reported in the study, 83% of patients in the insulin group and 72% of patients in the oral medication group completed the study. Hemoglobin A1c levels were similar in the two groups (6.1% in the insulin group and 6.0% in the oral group) and overall, the rate of hypoglycemia was "very low," according to the researchers, especially given the tight glycemic control achieved. 

In fact, "contrary to what might have been expected," the insulin group had fewer hypoglycemic events, although not to a statistically significant extent. Rates of mild events per person-month were 0.51 with insulin and 0.68 with oral medication, and rates of severe events per person-year were 0.04 in the insulin group and 0.09 in the oral group. 

Patients in both groups gained weight, "But while the weight gain persisted over time in the group treated with oral hypoglycemic agents, the weight gain in the insulin-treated group leveled off after 18 months and even regressed towards baseline," the investigators report. 

Importantly, the investigators say, compliance, treatment satisfaction, and quality of life were similar between the groups, with 100% of patients in the insulin group indicating that they would be willing to continue this form of treatment. 

"Insulin is the most effective hypoglycemic agent in our treatment armamentarium," the authors note. Moreover, mounting evidence suggests "that early treatment with insulin may preserve beta-cell function." 

This study, suggests that insulin is "a safe, effective, well-tolerated and well-accepted alternative for long-term treatment of Type 2 diabetes, even from the first day of diagnosis, in treatment naive patients." 

Insulin "should not be viewed as a treatment of last resort," the research team concludes.