Diabetology Xagena

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Type 2 diabetes and short-term intensive Insulin therapy

Studies have shown that, when implemented early in the course of type 2 diabetes mellitus, treatment with intensive Insulin therapy for 2-3 weeks can induce a glycaemic remission, wherein patients are able to maintain normoglycaemia without any anti-diabetic medication.
Investigators thus did a systematic review and meta-analysis of interventional studies to assess the effect of short-term intensive Insulin therapy on the pathophysiological defects underlying type 2 diabetes mellitus ( pancreatic beta-cell dysfunction and insulin resistance ) and identify clinical predictors of remission.

Researchers have identified studies published between 1950 and 2012, which have assessed the effect of intensive Insulin therapy on beta-cell function or insulin resistance, or both, or assessed long-term drug-free glycaemic remission in adults aged 18 years or older with newly diagnosed type 2 diabetes mellitus.

A total of 1645 studies of which seven fulfilled inclusion criteria ( n=839 participants ) was identified. Five studies were non-randomised.

A pooled analysis of the seven studies showed a post-intensive Insulin therapy increase in HOMA ( Homeostasis Model Assessment ) of beta-cell function as compared with baseline ( 1.13 ) and a decrease in HOMA of Insulin Resistance ( -0.57 ).

In the four studies that assessed glycaemic remission ( n=559 participants ), the proportion of participants in drug-free remission was about 66.2% ( 292 of 441 patients ) after 3 months of follow-up, about 58.9% ( 222 of 377 patients ) after 6 months, about 46.3% ( 229 of 495 patients ) after 12 months, and about 42.1% ( 53 of 126 patients ) after 24 months.

Patients who achieved remission had higher body-mass index ( BMI ) than those who did not achieve remission ( 1.06 kg/m2 ) and lower fasting plasma glucose ( -0.59 mmol/L ) at baseline.

In conclusion, short-term intensive Insulin therapy can improve the underlying pathophysiology in early type 2 diabetes mellitus, and thus might provide a treatment strategy for modifying the natural history of diabetes. ( Xagena )

Kaercher Kramer C et al, The Lancet Diabetes & Endocrinology 2013; 1: 28-34