INDUCTION OF LONG-TERM GLYCEMIC CONTROL IN NEWLY-DIAGNOSED TYPE-2 DIABETIC-PATIENTS BY TRANSIENT INTENSIVE INSULIN-TREATMENT

OBJECTIVE - Type 2 diabetes is a slowly progressive disease, in which the gradual deterioration of glucose tolerance is associated with the progressive decrease in beta-cell function. Hyperglycemia per se has d eleterious effects on both beta-cell function and insulin action, whic h are partially reversible by the short-term control of blood glucose levels. We hypothesized that the induction of euglycemia, using intens ive insulin therapy at the time of clinical diagnosis, could lead to a significant improvement in insulin secretion and action and thus alte r the clinical course of the disease. RESEARCH DESIGN AND METHODS - Th irteen newly diagnosed diet-unresponsive type 2 diabetic patients were treated with continuous subcutaneous insulin infusion (CSII) for 2 we eks and followed longitudinally while being treated with diet alone. R ESULTS - Four patients were considered therapeutic failures since CSII failed to induce euglycemia (n = 1) or glucose control deteriorated w ithin 6 months after CSII (n = 3). The remaining nine patients were ma intained on diet alone with adequate control from 9 to >50 months (med ian +/- SE, 26 +/- 4.8 months). In five patients, glycemic control det eriorated after 9-36 months, but a repeat 2-week CSII treatment reesta blished control in four patients. One of these patients underwent a th ird CSII treatment 13 months later. Ar the time this article was writt en, six patients of the initial group were still controlled without me dication 16-59 months (median +/- SE, 45.5 +/- 6.6 months) after the i nitiation of treatment. Body weight remained unchanged in all patients . CONCLUSIONS - These findings suggest that in a significant proportio n of type 2 diabetic patients who fair to respond to dietary measures, short-term intensive insulin treatment can effectively establish resp onsiveness, allowing long-term glycemic control without medication. Fu rther studies are required to establish whether simpler treatment regi mens could be equally effective. If the hypothesis offered here finds support, present approaches to the management of newly diagnosed type 2 diabetes may need to be revised.