Maybe Type 2 Diabetics Should Start Insulin before Oral Meds . . .

When I was diagnosed with type 2 diabetes about 12 years ago, I heaved a sigh of relief when I was told “You’ll probably never need to take insulin”. Having gradually increased my oral medications, I’ve been able to taper them off a bit recently. But it seems I may have missed an opportunity. A new study from China, published in the journal Lancet, shows that patients with newly-diagnosed type 2 diabetes respond better to intensive treatment with insulin than with oral medications.

Over 380 newly-diagnosed adults, of average age 51, were randomly assigned to short-term intensive therapy with either insulin (a continuous subcutaneous infusion or multiple daily injections) or oral antidiabetic meds. Treatment was stopped when patients had maintained normal glucose levels for 2 weeks, and the patients were followed up with diet and exercise alone.
Glycemic control was achieved with insulin within 4 days, on average, by 96% of the patients, compared with 84% of the oral-drug recipients, who reached control within 9 days. At 1 year, roughly half the insulin- treated patients required no medication, compared with about 25% of the patients originally given oral meds.
The researchers explain this difference as being because early intensive glycemic control may prevent early irreversible loss of beta-cells in the pancreas that normally leads to worsening of diabetes. If further studies confirm these results, it may mean a sea-change in the management of newly-diagnosed type 2 diabetes. . .