Early Initiation of Insulin Therapy in Newly Diagnosed Patients with Type 2 Diabetes and Exploring the Legacy Effect—A Single-arm Prospective Observational Study
Early insulin initiation, Intensive glycemic control, Metabolic memory
Citation Information :
Early Initiation of Insulin Therapy in Newly Diagnosed Patients with Type 2 Diabetes and Exploring the Legacy Effect—A Single-arm Prospective Observational Study. Bengal Physician Journal 2020; 7 (3):52-54.
Background: Early insulin has the potential to not only provide glycemic benefit and β-cell salvage but also reduce microvascular and macrovascular complications. Several reports have shown that the short-term intensive insulin therapy can induce long-term glycemic control in newly diagnosed type 2 diabetes mellitus (T2DM) patients with mild to moderate hyperglycemia. Thus, we hypothesize that a 2-month intensive glycemic control using glargine in newly diagnosed T2DM patients will provide glycemic and legacy benefit.
Objective: To assess whether 2-month treatment with insulin in newly diagnosed T2DM patients (HbA1c >9%) brings about long-term glycemic control even after stopping insulin after 2 months and also reduction in requirement of other antidiabetic agents.
Method: A prospective single-arm observational study included subjects initiated on insulin, which was stopped after 2 months and lifestyle modification was advised along with oral antidiabetes drugs thereafter. For the initial 2 months, the patients were reviewed weekly and fasting capillary blood glucose was aimed to be maintained between 80 and 130 mg/dL. The included subjects were followed up every 3 months, for a period of 1 year for glycemic parameters.
Results: The study included patients who demonstrated intensive glycemic control with early insulin use. These patients who were followed up over a year in interval of 3 months demonstrated a steep reduction in glycemic indices with time. A steady reduction in mean antidiabetic medications in the subjects was seen over the time period.
Conclusion: Early insulin initiation may result in long-term benefits. Optimum glycemic control in the early stage of diabetes using insulin provides legacy effects and good metabolic memory.
Chen C, Cohrs CM, Stertmann J, et al. Human beta cell mass and function in diabetes: recent advances in knowledge and technologies to understand disease pathogenesis. Mol Metab 2017;6(9):943–957. DOI: 10.1016/j.molmet.2017.06.019.
Cerf ME. Beta cell dysfunction and insulin resistance. Front Endocrinol (Lausanne) 2013;4:37. DOI: 10.3389/fendo.2013.00037.
Owens DR. Clinical evidence for the earlier initiation of insulin therapy in type 2 diabetes. Diabetes Technol Ther 2013;15(9):776–785. DOI: 10.1089/dia.2013.0081.
Silver B, Ramaiya K, Andrew SB, et al. EADSG guidelines: insulin therapy in diabetes. Diabetes Ther 2018;9(2):449–492. DOI: 10.1007/s13300-018-0384-6.
Alvarsson M, Sundkvist G, Lager I, et al. Beneficial effects of insulin versus sulphonylurea on insulin secretion and metabolic control in recently diagnosed type 2 diabetic patients. Diabetes Care 2003;26(8):2231–2237. DOI: 10.2337/diacare.26.8.2231.
Ryan EA, Imes S, Wallace C. Short-term intensive insulin therapy in newly diagnosed type 2 diabetes. Diabetes Care 2004;27(5):1028–1032. DOI: 10.2337/diacare.27.5.1028.
Li Y, Xu W, Liao Z, et al. Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients is associated with improvement of β-cell function. Diabetes Care 2004;27(11):2597–2602. DOI: 10.2337/diacare.27.11.2597.
Chen HS, Wu TE, Jap TS, et al. Beneficial effects of insulin on glycemic control and beta-cell function in newly diagnosed type 2 diabetes with severe hyperglycemia after short-term intensive insulin therapy. Diabetes Care 2008;31(10):1927–1932. DOI: 10.2337/dc08-0075.
Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature 2001;414(6865):813–820. DOI: 10.1038/414813a.
Gross ML, Heiss N, Weckbach M, et al. ACE-inhibition is superior to endothelin A receptor blockade in preventing abnormal capillary supply and fibrosis of the heart in experimental diabetes. Diabetologia 2004;47(2):316–324. DOI: 10.1007/s00125-003-1309-z.
Mauer SM, Steffes MW, Ellis EN, et al. Structural-functional relationships in diabetic nephropathy. J Clin Invest 1984;74(4):1143–1155. DOI: 10.1172/JCI111523.
Mizushige K, Yao L, Noma T, et al. Alteration in left ventricular diastolic filling and accumulation of myocardial collagen at insulin-resistant prediabetic stage of a type II diabetic rat model. Circulation 2000;101(8):899–907. DOI: 10.1161/01.cir.101.8.899.
Testa R, Bonfigli AR, Prattichizzo F, et al. The “metabolic memory” theory and the early treatment of hyperglycemia in prevention of diabetic complications. Nutrients 2017;9(5):437. DOI: 10.3390/nu9050437.
Berezin A. Metabolic memory phenomenon in diabetes mellitus: achieving and perspectives. Diabetes Metab Syndr 2016;10(2 Suppl. 1):S176–S183. DOI: 10.1016/j.dsx.2016.03.016.
Doyle-Delgado K, Chamberlain JJ, Shubrook JH, et al. Pharmacologic approaches to glycemic treatment of type 2 diabetes: synopsis of the 2020 American Diabetes Association's Standards of Medical Care in Diabetes Clinical Guideline. Ann Intern Med 2020;173(10):813–821. DOI: 10.7326/M20-2470.
AACE. Glycemic management in type 2 diabetes. Accessed from: https://pro.aace.com/disease-state-resources/diabetes/depth-information/glycemic-management-type-2-diabetes [Accessed on March 15, 2021].