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Insulin for Early Type 2 Diabetes?
Start on Insulin not sulfonylurea for better control and save beta cells. Study Suggests It Helps Patients Maintain Metabolic Control. For patients recently diagnosed with adult-onset (i.e., type 2) diabetes, insulin treatment achieves better results than does therapy with oral medication, Swedish researchers report.

Insulin is widely thought of as a treatment of last resort for patients with type 2 diabetes, but new research may help change that thinking. Early insulin therapy resulted in better control than that seen with oral medications in a new study done in Sweden.

Researchers suggest that early insulin therapy can help patients maintain the ability to produce their own insulin longer. In addition, early insulin therapy is not associated with hypoglycemia or weight gain and does not negatively affect volunteers' cholesterol levels, researchers say. These are all common reasons doctors delay prescribing insulin therapy.

Researcher Michael Alvarsson, MD, PhD, says the message is not that all, or even most, people with type 2 diabetes should be on insulin from the start, but that doctors should not delay giving insulin to patients who may need it. Endocrinologist Nathaniel Clark, MD, of the American Diabetes Association (ADA), agrees.

Dr Clark feels that "Insulin is simply another treatment for type 2 diabetes, and, like other treatments, it has its pluses and its minuses.. "But, unfortunately, clinicians tend to see it as the treatment they turn to when oral medications have failed, so it is no surprise that patients fear it."

The two-year Swedish study included 39 adults newly diagnosed with type 2 diabetes. They were randomly assigned to treatment with either twice-daily injections of insulin or a widely prescribed oral drug called a sulfonylurea.

After a year of treatment, the patients who had taken insulin were better able to produce their own insulin than those taking the oral medication. The ability to produce insulin was similar in the two groups after two years of treatment, but the insulin-treated group had better blood sugar control. . And the patients on insulin therapy experienced none of the side effects that have been linked to its use, such as weight gain and elevated cholesterol.

Thus, the team concludes that initially treating type-2 diabetic patients with insulin helps maintain their own production of insulin, at least temporarily, and helps control blood sugar levels.
The findings are published in the August issue of the ADA publication Diabetes Care.

Most adults who develop diabetes have the type-2 form, also known as non-insulin dependent diabetes, and are usually treated with an oral drug such as a sulfonylurea to improve their responsiveness to insulin or to increase insulin output.

However, as Dr. Michael Alvarsson of the Karolinska Hospital, Stockholm, and associates note in the journal Diabetes Care, there haven't been many studies "that rigorously compare the effects of sulfonylurea versus insulin treatment on the deterioration of insulin secretion in type 2 diabetic patients."

"Our findings need to be confirmed, but they suggest that early insulin treatment can result in better metabolic control," Alvarsson says. "Overall, I think clinicians are too reluctant to give this treatment to patients with early disease."

Allison Goldfine, MD, believes that the epidemic of type 2 diabetes has intensified the search for effective ways of delaying disease progression. The disease is no longer confined to patients who are middle aged and older, but is now commonly seen among young adults, teens, and even children as the epidemic of obesity extends to this age group. Goldfine is an assistant professor at Harvard Medical School and an investigator with the Joslin Diabetes Center.
If insulin treatment had been started even earlier, he added, "We might have seen more lasting effects of insulin." Diabetes Care 2003;26:2231-2237.

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DID YOU KNOW: A recent study has shown that obese grils are more likely to suffer from impaired glucose tolerance (IGT) than obese boys. (ADA July 7, 2003). This puts them at higher risk of Type 2 diabetes in later years. The study which was presented at the Annual meeting of the ADA studied a sample of 68 obese boys and 66 obese girls of about 12 years of age.