Better Outcomes With Insulin for Newly Diagnosed Type 2 Diabetes

Insulin provides better glycemic control and improvement in beta-cell function than do oral antidiabetes drugs in patients newly diagnosed with type 2 diabetes with severe hyperglycemia, according to a report in the October issue of Diabetes Care.

Several earlier reports have shown that short-term intensive therapy with insulin can provide long-term glycemic control in newly diagnosed patients with type 2 diabetes, the authors explain, though more than half of such patients will require oral antidiabetes drugs within 1 year.

Dr. Harn-Shen Chen from Taipei Veterans General Hospital in Taiwan and colleagues evaluated whether treatment with insulin has any advantages over oral antidiabetes drugs in 50 patients with newly diagnosed type 2 diabetes with severe hyperglycemia.

During 6 months of follow-up, fasting plasma glucose (FPG) levels remained stable in the insulin group, the authors report, whereas FPG increased in week 2 and week 4 and then gradually decreased in the oral antidiabetes drug group.

A1c levels were significantly lower in the insulin group than in the oral antidiabetes drug group at the end of the study, and the proportion of patients reaching A1c targets of <6.5% or <7.0% was significantly greater in the insulin group.

Most measures of beta-cell function and insulin resistance improved significantly more in the insulin group than in the oral antidiabetes drug group, the researchers note.

None of the patients experienced severe hypoglycemia, the report indicates, and there was no difference between the two groups in the overall rate of minor hypoglycemia.

"Intensive insulin therapy for 10-14 days can achieve optimal glycemic control in newly diagnosed type 2 diabetes with severe hyperglycemia but cannot induce a long-term glycemic control," the investigators say. "A 6-month course of further insulin therapy, compared with oral antidiabetes drug treatment, could more effectively maintain adequate glycemic control accompanied with significant improvement of beta-cell function."

"Therefore," the authors conclude, "in the management of newly diagnosed type 2 diabetic patients with severe hyperglycemia, strong consideration should be given to early, aggressive insulin therapy for a rapid and sustained effect on glycemic control and beta-cell function."

Diabetes Care 2008;31:1927-1932.

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