Benefits of early insulin therapy in newly diagnosed type 2 diabetes

Introduction of short term insulin therapy in the early stages of type 2 diabetes has shown to have long lasting effects. It helps to improve both the sensitivity and secretion of insulin and re-establish optimal glycaemic control and also reduce lipotoxicity and glucose toxicity (1)

• a number of studies have shown that short term aggressive insulin replacement (via multiple daily insulin injections, or insulin pump therapy) as first-line therapy in patients with newly diagnosed type 2 diabetes resulted in around 90% of patients achieving euglycaemia on completion of therapy. After discontinuing insulin, diet therapy was used to maintain the patient and 42-69% continued to be euglycaemic 12 or more months after insulin treatment (2)
  
  
• Ilkova et al have demonstrated that moderate doses of insulin in a newly diagnosed mildly overweight hyperglecaemic patients resulted in near-normoglycaemia within days after initiating therapy. The patients were treated for 2 weeks and adequate glycaemic control were observed in 85% of patients (who were controlled on diet alone) for at least 6 months after discontinuing treatment (3)

Early insulin therapy may also benefit in delaying:

• the progression of type 2 diabetes
• the progression of associated macrovascular and microvascular complications (1)

Once the patients achieve restoration of beta cell function, they should be maintained with diet, weight control and exercise (1).

Long term studies should be done to look for further benefits of early insulin therapy on beta cell function and micro and macrovascular complications in a patient with type 2 diabetes (1).

Reference:

• 1. Palumbo PJ. The case for insulin treatment early in type 2 diabetes. Cleve Clin J Med. 2004;71(5):385-6, 391-2, 394 passim
• 2. Meneghini LF .Early insulin treatment in type 2 diabetes: what are the pros? Diabetes Care. 2009;32 Suppl 2:S266-9.
• 3. Ilkova H et al. Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients by transient intensive insulin treatment. Diabetes Care. 1997;20(9):1353-6.