Diabetes Obes Metab: In early type 2 diabetes, short-term intensive insulin can be used as an induction and maintenance therapy to protect the function of pancreatic β-cells

The drug treatment of type 2 diabetes (T2D) usually starts with metformin monotherapy, and when the blood glucose index is no longer reached, other hypoglycemic drugs are added in sequence
.

In practice, the annual failure rate of metformin monotherapy is 17%, that is, glycosylated hemoglobin exceeds the treatment target of 7.

The drug treatment of type 2 diabetes (T2D) usually starts with metformin monotherapy, and when the blood glucose index is no longer reached, other hypoglycemic drugs are added in sequence

Methods: In this multicenter randomized controlled trial, 108 adults with type 2 diabetes (median duration 1.
3 years; HbA1c (6.
6% ± 0.
6%)) were randomly divided into 3 weeks to induce IIT (insulin glargine, lispro) In the MET maintenance group, a 2-week course of IIT was performed every 3 months for 2 years
.

An oral glucose tolerance test was performed every 3 months, and β-cell function was evaluated by the insulin secretion sensitivity index-2 (isi -2)

Results: In the two groups, induction of IIT increased isi-2, improved systemic insulin sensitivity, and decreased liver insulin resistance (allP≤.
0004)
.

The main outcome of baseline-adjusted ISI -2 at 2 years did not improve due to the addition of intermittent IIT (MET+IIT), and the main outcome of the MET group was slightly higher (baseline adjustment difference ?35 [95% confidence interval: ?66, -3 ]), the other three beta cell measurement results showed no significant difference

Table 1 After 3 weeks of induction of IIT, the changes of metabolic indicators in each group compared with baseline

Table 1 After 3 weeks of induction of IIT, the changes of metabolic indicators in each group compared with baseline

Table 2 Major, minor and other results for 2 years

Table 2 Major, minor and other results for 2 years

Figure 1 (A) The proportion of subjects with HbA1c≤6.
0% in the two groups at each study visit; (B) Among the subjects who took metformin before the test, the subjects with glycosylated hemoglobin≤6.
0% at each study visit Proportion
.

IIT, intensive insulin therapy

Figure 1 (A) The proportion of subjects with HbA1c≤6.

Figure 2 (A) ISSI-2, (B) HbA1c, (C) fasting blood glucose, (D) BMI, (E) Matsuda index and (F) HOMA-IR over time
.

The mean and standard error are shown

Figure 2 (A) ISSI-2, (B) HbA1c, (C) fasting blood glucose, (D) BMI, (E) Matsuda index and (F) HOMA-IR over time

Although the initial induction of IIT induced metabolic improvement, the subsequent IIT course of treatment every 3 months could not further enhance the effect of MET maintenance treatment on β-cell function

Retnakaran R, Emery A, Ye C, et al.

.
Short-term intensive insulin as induction and maintenance therapy for the preservation of beta-cell function in early type 2 diabetes (RESET-IT Main): A 2-year randomized controlled trial in this message