Repeat programs of intensive insulin don’t ‘reset the clock’ in sort 2 diabetes


medwireNews: A recurring short, intense insulin course every 3 months does not build on metabolic improvements that were achieved through an induction course of relatively short duration in people with type 2 diabetes, researchers say.

All 108 participants in the randomized controlled study had a 3-week induction course with intensive basal bolus insulin. At the time of admission, these individuals had type 2 diabetes with a mean duration of 1.3 years and a mean glycated hemoglobin level of 6.6% (49 mmol / mol).

As expected, results from oral glucose tolerance tests performed before and after initial insulin therapy indicated that this was beta cell function (based on insulin secretion sensitivity index-2), whole body insulin sensitivity, liver insulin resistance, and significantly improved blood sugar levels.

For the next 2 years, all participants took metformin, while 53 took it continuously, 55 participants took it off every 3 months for 2 weeks, again receiving basal bolus insulin therapy.

Although these intense treatment periods successfully lowered glucose levels to the same extent as the original course, they had no lasting metabolic effects, report Ravi Retnakaran (Mount Sinai Hospital, Toronto, Ontario, Canada) and study co-authors.

The primary result of the baseline-adjusted insulin secretion sensitivity index -2 after 2 years was not significantly different between the groups and was even slightly higher in the metformin-only group.

There were also no treatment-related differences in other measurements of beta cell function or in glycated hemoglobin or fasting glucose levels.

“These results may reflect the finite window of time in the natural history of diabetes when there is a significant reversible component of beta-cell dysfunction to respond to [intensive insulin therapy]”The researchers write in the areas of diabetes, obesity and metabolism.

They add that the data “suggests that despite the initial metabolic benefits, they are short-term [intensive insulin therapy] does not prematurely reset the clock underlying the reversibility window of beta cell dysfunction [type 2 diabetes]. ”

In exploratory analyzes, the team found no difference in beta cell function between treatment groups in people with diabetes of less than 2.5 years in duration. In contrast, there was a marked difference between patients with longer duration of diabetes, with better beta cell function observed in patients using metformin only.

The researchers speculate that discontinuing metformin treatment may have been detrimental in people with prolonged diabetes, given the lack of benefit from repeated insulin courses.

“In practice, our results therefore do not support the use of intermittent material [intensive insulin therapy] as a long-term strategy to maintain beta cell function, ”they conclude.

medwireNews is an independent medical news service from Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

Diabetes Obes Metab 2021; doi: 10.1111 / dom.14421