Insulin is usually considered as the last resort for persons with diabetes. But a study has found that short-term insulin therapy at the time of diagnosis of Type 2 diabetes could lead to good long-term glycaemic control and improved beta cell function.
Doctors and researchers at Dr. Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation studied 426 treatment-naive patients (243 men and 183 women) of Type 2 diabetes with known duration of diabetes for less than three months. Those with high blood sugar level and glycated haemoglobin (HbA1c) of above nine or 10% were included, according to V. Mohan, one of the authors of the study that was recently published in the Journal of Diabetology.
“Many think that insulin is the last resort. Even traditionally, insulin is given after all medications fail. But this was until five years ago when studies started to show that insulin can be given at the time of diagnosis,” he said.
At the time of diagnosis, the beta cell function is very low — at about 20%, he said, adding: “This is due to glucotoxicity. The glucose surrounds the beta cells and it cannot secrete insulin, and does not function properly. So, in our study, we started patients on drugs along with small doses of insulin. They were given one shot of insulin once a day for one month,” Dr. Mohan, who is the chairman and chief of diabetology of the centre, said.
Doctors found that there was significant reduction in both fasting plasma glucose and postprandial plasma glucose. “There was a dramatic improvement as the sugar levels reduced. HbA1c was normal in almost all. In some, there was a dramatic reduction; 12.7% of individuals achieved HbA1c less than 5.6% that is considered as normal,” he said.
Only one individual of the 426 patients had to be continued on insulin, 13 individuals were managed only on diet for the next one year, 101 individuals were put on an oral single-drug therapy, 212 individuals required dual-drug therapy and 99 required triple-drug therapy to maintain HbA1c less than 7.0%, the study said.