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Cited by 269Diabetes Treatment and ManagementDiabetes Management and ResearchPancreatic function and diabetes

Induction of Long-Term Glycemic Control in Newly Diagnosed Type 2 Diabetic Patients by Transient Intensive Insulin Treatment

Ilkova, Hasan, Glaser, Benjamin, Tunçkale, Aydin, Bagriaçik, Nazif, Cerasi, Erol·1997·Diabetes Care
DOI 10.2337/diacare.20.9.1353
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Abstract

OBJECTIVE: Type 2 diabetes is a slowly progressive disease, in which the gradual deterioration of glucose tolerance is associated with the progressive decrease in β-cell function. Hyperglycemia per se has deleterious effects on both beta-cell function and insulin action, which are partially reversible by the short-term control of blood glucose levels. We hypothesized that the induction of euglycemia, using intensive insulin therapy at the time of clinical diagnosis, could lead to a significant improvement in insulin secretion and action and thus alter the clinical course of the disease. RESEARCH DESIGN AND METHODS: Thirteen newly diagnosed diet-unresponsive type 2 diabetic patients were treated with continuous subcutaneous insulin infusion (CSII) for 2 weeks and followed longitudinally while being treated with diet alone. RESULTS: Four patients were considered therapeutic failures since CSII failed to induce euglycemia (n = 1) or glucose control deteriorated within 6 months after CSII (n = 3). The remaining nine patients were maintained on diet alone with adequate control from 9 to > 50 months (median ± SE, 26 ± 4.8 months). In five patients, glycemic control deteriorated after 9–36 months, but a repeat 2-week CSII treatment reestablished control in four patients. One of these patients underwent a third CSII treatment 13 months later. At the time this article was written, six patients of the initial group were still controlled without medication 16–59 months (median ± SE, 45.5 ± 6.6 months) after the initiation of treatment. Body weight remained unchanged in all patients. CONCLUSIONS: These findings suggest that in a significant proportion of type 2 diabetic patients who fail to respond to dietary measures, short-term intensive insulin treatment can effectively establish responsiveness, allowing long-term glycemic control without medication. Further studies are required to establish whether simpler treatment regimens 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.

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  • Aggressive lowering of glycemia, especially with insulin therapy, in newly diagnosed diabetes can result in sustained remissions, i.e., normoglycemia without need for glucose-lowering medications.

    “Mounting evidence suggests that aggressive lowering of glycemia, especially with insulin therapy, in newly diagnosed diabetes can result in sustained remissions, i.e., normoglycemia without need for glucose-lowering medications (87,88).”

    From Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy (2009) · cites this paper as [87]

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Authors
Ilkova, H., Glaser, B., Tunçkale, A., Bagriaçik, N., & Cerasi, E.
Affiliations
  • Istanbul University-Cerrahpaşa (TR)
  • Department of Endocrinology and Metabolism, Hebrew University Hadassah Medical Center Jerusalem, Israel
  • Department of Internal Medicine, Division of Metabolism and Diabetes, Istanbul University Cerrahpasa Medical Faculty Istanbul, Turkey
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
1997-09-01
Volume
20
Issue
9
Pages
1353-1356
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/diacare.20.9.1353
OpenAlex
W2094434238
Cited by
269
References
13
Citations by year
2026: 1 · 2025: 4 · 2024: 4 · 2023: 12 · 2022: 6 · 2021: 3 · 2020: 5 · 2019: 7 · 2018: 10 · 2017: 7 · 2016: 14 · 2015: 13 · 2014: 17 · 2013: 18 · 2012: 19
FWCI
1.42
Type
journal article
Language
en
Open access
closed
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
Keywords
type 2 diabetes, newly diagnosed diabetes, intensive insulin therapy, insulin pump therapy, glycemic control, beta-cell function, insulin secretion, insulin action
MeSH terms
Adult, Aged, Blood Glucose, C-Peptide, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Humans, Hypoglycemic Agents, Infusion Pumps, Insulin, Male, Middle Aged, Time Factors

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