Korean J Intern Med.  2010 Sep;25(3):273-281. 10.3904/kjim.2010.25.3.273.

The Effect of Early Insulin Therapy on Pancreatic beta-Cell Function and Long-Term Glycemic Control in Newly Diagnosed Type 2 Diabetic Patients

• Chon S
• Oh S
• Kim SW
• Kim JW
• Kim YS
• Woo JT

• KMID: 1776608
• DOI: http://doi.org/10.3904/kjim.2010.25.3.273

Abstract

BACKGROUND/AIMS
Based on the results of well designed clinical studies, intensive insulin therapy has been established to improve glycemic control in newly diagnosed diabetes. However, discrepancies exist between the findings of clinical trials and experiences in general practice. Furthermore, the efficacy of an early insulin therapy (EIT) - commonly used in general practice - on long-term glycemic control has not been established. Therefore, we evaluated the effects of EIT on pancreatic beta-cell function and glycemic control using insulin-based methods widely employed in general practice.
METHODS
We performed a retrospective cohort study that initially involved reviewing patients' medical records. Following a thorough review, 61 patients who received either biphasic or prandial EIT at the time of diagnosis were enrolled. We then evaluated changes in beta-cell function and glycemic control during a 48-month follow-up period.
RESULTS
Mean HbA1c decreased significantly as a result of EIT from 10.7 +/- 1.8% to 6.2 +/- 1.1% (p < 0.001). On average, 2.6 months was required to achieve an HbA1c value < 7%. EIT significantly improved the insulinogenic index. Glycemic control was well maintained for 48 months. More than 70% of patients were able to maintain glycemic control following lifestyle modifications or treatment with oral antidiabetic drugs. No significant differences were identified between patients receiving biphasic EIT and prandial EIT in terms of glycemic control or pancreatic beta-cell function.
CONCLUSIONS
Our results suggest that regardless of the method of delivery, EIT significantly improves beta-cell function and facilitates long-term glycemic control in patients with newly diagnosed type 2 diabetes mellitus.

Keyword

Insulin; Diabetes mellitus, type 2; Insulin-secreting cells

MeSH Terms

Administration, Oral
Adult
Blood Glucose/metabolism
Cohort Studies
Diabetes Mellitus, Type 2/blood/diagnosis/*drug therapy/*physiopathology
Female
Hemoglobin A, Glycosylated/metabolism
Humans
Hypoglycemic Agents/administration & dosage
Insulin/administration & dosage/*therapeutic use
Insulin Resistance
Insulin-Secreting Cells/*drug effects/*physiology
Male
Middle Aged
Retrospective Studies