Adapted from BMJ 19 October 2024
My comments: Decades ago it was found that newly diagnosed type twos who were put on insulin clamps for two weeks, recovered beta cell function, and had better blood sugars over the next two years, than their compatriots who had usual treatment.
For as long as I can remember, type twos, on diagnosis, have been given a step up regime. In this dietary strategies are employed, then metformin, then other drugs and eventually insulin. This procedure can last years.
In China, L Liu et al, they embarked on a trial of immediate insulin via insulin pumps for two to three weeks, and then randomised the patients to one of three oral medication regimes or lifestyle advice, who acted as the control subjects.
The study was conducted across 15 centres in China. 412 patients took part. The mean BMI was 25.8 and the duration of diabetes at onset was a median of one month.
The insulin pumps were sent to deliver a fasting or pre-meal blood sugar of 6.1 mmol/l and two hour post meal blood sugars of less than 8 mmol/litre.
The mean HbA1c was around 11% on diagnosis and on the pumps fell to around 9.4% after two weeks. At the twelve week mark all groups has HbA1cs of around 6 to 6.5%.
After 48 weeks the proportions of patients who still had HbA1cs under 7% were calculated.
The most successful intervention was Linagliptan 5mg + Metformin 1000mg a day. 80% of these patients had HbA1cs under 7%.
Next was Metformin 1000mg only at 73% closely followed by Linagliptan 5mg only at 72%.
Lastly came “lifestyle” only at 60%.
Other outcomes measured were beta cell function and insulin sensitivity.
Authors have shown that the intensive insulin treatment and step down approach gives excellent long term glycaemic control in patients with severe hyperglycaemia in newly diagnosed type two patients.
In patients who are willing to undergo training on pump using on diagnosis, surely this would be a better way to manage diabetes than our “usual” treatment.
Published by
