Effect of intensive insulin therapy on β-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomised parallel-group trial

Weng, Jianping; Li, Yanbing; Xu, Wen; Shi, Lixin; Zhang, Qiao; Zhu, Dalong; Hu, Yun; Zhou, Zhiguang; Yan, Xiang; Tian, Haoming; Ran, Xingwu; Luo, Zuojie; Xian, Jing; Yan, Li; Li, Fangping; Zeng, Longyi; Chen, Yanming; Yang, Liyong; Yan, Sunjie; Liu, Juan; Li, Ming; Fu, Zhen-Yan; Cheng, Hua

doi:10.1016/s0140-6736(08)60762-x

Cited by 707 publications

(755 citation statements)

References 19 publications

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“…Mounting evidence suggests that aggressive lowering of glycaemia, especially with insulin therapy, in newly diagnosed diabetes can result in sustained remissions, i.e. normoglycaemia without need for glucoselowering medications [87,88]. Type 2 diabetes is a progressive disease [89] and patients should be informed that they are likely to require the addition of glucoselowering medications over time.…”

Section: Algorithmmentioning

confidence: 99%

Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy

et al. 2008

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The consensus algorithm for the medical management of type 2 diabetes was published in August 2006 with the expectation that it would be updated, based on the availability of new interventions and new evidence to establish their clinical role. The authors continue to endorse the principles used to develop the algorithm and its major features. We are sensitive to the risks of changing the algorithm cavalierly or too frequently, without compelling new information. An update to the consensus algorithm published in January 2008 specifically addressed safety issues surrounding the thiazolidinediones. In this revision, we focus on the new classes of medications that now have more clinical data and experience.

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Section: Algorithmmentioning

confidence: 99%

Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy

et al. 2008

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“…However, we did not have data of CPR in all subjects and it has not been elucidated whether these markers become predictors of the cessation of insulin therapy. Conversely, it has been reported that β-cell function in newly diagnosed T2DM patients recovers following intensive insulin therapy [5,6]. These observations suggest that remission may occur more commonly in patients with a shorter duration of diabetes because β-cell function in these patients has the potential to recover.…”

Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 99%

“…Some studies have demonstrated that early intensive insulin therapy for a short time in patients with newly diagnosed T2DM may achieve near-normoglycemic remission [5,6]. These studies suggest that elimination of glucotoxicity by intensive insulin therapy may improve β-cell function and achieve remission [5,6]. Conversely, sulfonylureas may exert negative effects on β-cells by overstimulation and the induction of desensitization, which is known as "secondary failure" [7,8].…”

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confidence: 99%

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Short duration of diabetes and disuse of sulfonylurea have any association with insulin cessation of the patients with type 2 diabetes in a clinical setting in Japan (JDDM 30)

Arai¹,

Hirao²,

Yamauchi³

et al. 2013

Endocr J

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Type 2 diabeTes melliTus (T2DM) is characterized by defects in both insulin secretion and action. The UK Prospective Diabetes Study has reported that β-cell function deteriorates progressively over time in patients with T2DM, irrespective of lifestyle and existing pharmacological intervention [1,2]. Consequently, insulin therapy is often required to achieve good glycemic control [3] and, in fact, in the clinical setting in Japan, outpatients with T2DM are started on insulin therapy. Conversely, protraction of glycemic control without insulin therapy may be preferable for patients. However, the proportion of outpatients who were able to stop insulin therapy has not been determined, nor is there information as to which insulin treatment reg- abstract. Insulin therapy is often required to achieve good glycemic control for the patients with type 2 diabetes mellitus (T2DM), while protraction of glycemic control without insulin therapy may be preferable for patients. To determine the characteristics of and therapeutic regimen in outpatients with T2DM who were able to stop insulin therapy with satisfactory glycemic control in a real clinical practice setting in Japan by a case-control study. The present study was performed on 928 patients with T2DM who started insulin therapy in 2007. Data regarding age, sex, body mass index, duration of diabetes, HbA1c, postprandial plasma glucose, plasma fasting C-peptide immunoreactivity and treatment modality were compared between patients who were able to stop insulin therapy and those who continued with insulin. Of the 928 patients, 37 had stopped insulin therapy within 1 year. In the patients who stopped insulin therapy, the duration of diabetes was significantly shorter and the daily insulin dosage at initiation and the prevalence of sulfonylurea pretreatment significantly lower compared with patients who continued on insulin. In conclusion, almost 4% of T2DM patients were able to stop insulin therapy with satisfactory glycemic control in a real clinical practice setting in Japan. Shorter duration of diabetes and disuse of sulfonylureas prior to insulin may associate with stopping insulin therapy as a near-normoglycemic remission in outpatients with T2DM in Japan.

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“…Similar to that in Japanese patients, inadequate β‐cell response to increasing insulin resistance results in loss of glycemic control and increased risk of diabetes, even with relatively little weight gain, and seems to be the main defect to the progression of the disease in Chinese patients. Our recent study comparing intensive insulin therapy with oral hypoglycemic agents in newly diagnosed type 2 diabetes provided some further evidence 4 . A greater proportion of patients with intensive insulin therapy, in which treatment was withdrawn after 2 weeks of normoglycemia, achieved glycemic remission compared with oral agents by the end of 1 year.…”

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confidence: 98%

Diabetes in China: The challenge now

Weng¹,

2010

J of Diabetes Invest

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Effect of intensive insulin therapy on β-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomised parallel-group trial

Cited by 707 publications

References 19 publications

Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy

Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy

Short duration of diabetes and disuse of sulfonylurea have any association with insulin cessation of the patients with type 2 diabetes in a clinical setting in Japan (JDDM 30)

Diabetes in China: The challenge now

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