Early, Intense Diabetes Therapy Works

Type 2 diabetes patients preserve insulin production through early and intensive treatment

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) If your diabetes goes untreated, you could face a number of serious complications. But if you start battling diabetes early, you may have a better chance of controlling the disease.

Early intensive treatment may slow down the progression of type 2 diabetes by protecting the body's cells that make insulin - a natural hormone that regulates blood sugar levels.

"Seek treatment early if you have type 2 diabetes."

When type 2 diabetes is first diagnosed, many doctors recommend that patients start with healthy lifestyle changes to control their blood sugar.

Yet, a recent study from the University of Texas Southwestern Medical Center - where intensive treatment has been the standard for years - showed that early intensive treatment can preserve patients' ability to produce insulin for 3.5 years after diagnosis.

Ildiko Lingvay, MD, of UT Southwestern, and colleagues found that intensive treatment with insulin plus metformin - followed by either insulin plus metformin again or a three-drug treatment - protected the function of pancreatic beta cells.

Beta cells are cells in the pancreas that produce insulin. Without insulin, patients can be faced with dangerously high levels of blood sugar. However, if diabetes patients can keep producing insulin, the disease becomes much easier to control.

According to Dr. Lingvay, the intensive treatment approach is different than the approach recommended in standard guidelines.

"We believe that the [industry-recommended] stepwise approach exposes patients to long periods of high blood sugar, which leads to complications," she said.

"Unless dietary changes are significant and sustained long-term, diabetes is a progressive disease in which the body's ability to produce insulin declines," she said.

The study's results showed that patients can maintain insulin production, regardless of the drugs used in the intensive treatment approach.

The intensive treatments led to excellent blood sugar control, said Dr. Lingvay. The treatments were also well tolerated and safe, she said.

For the study, all patients were treated with insulin and metformin for 3 months. After the 3-month lead-in period, patients were split into two treatment groups: one that took three diabetes drugs daily (metformin, glyburide and pioglitazone) and one that continued taking insulin plus metformin.

Insulin production and blood sugar control improved for both groups.

"The point is that whatever you choose, make sure it's intensive," said Dr. Lingvay.

"We have shown that this preserves beta-cell function, and that's the key in changing the course of the disease," she said.

The study was small, with only 58 patients. As such, larger studies are needed to confirm these results.

The research received support from the National Institutes of Health and Novo Nordisk Inc., a supplier of insulin. Novo Nordisk had no part in the design, conduct, analysis, preparation or final approval of the study.

The results are published in Diabetes Care, a journal of the American Diabetes Association.

Reviewed by: 
Review Date: 
July 1, 2012
Last Updated:
December 5, 2012