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Should insulin shots be administered immediately upon diagnosis of type 2 diabetes?
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A Journal of the ADA
The treatment goal for anyone with diabetes is to control blood sugar. Insulin is one of the most powerful drugs in our arsenal for this purpose. Despite this, insulin is used as the drug of last resort. There is hesitance from doctors to prescribe insulin too early. They worry about hypoglycemia and weight gain. There is also resistance from patients. This is, in part, fear of needles but also, in part, a fear of disease progression. Apart from the dislike of daily injections which is very reasonable, all other concerns are unwarranted. Indeed, evidence suggests that insulin administration helps to maintain the health and function of the remaining beta cells.
The best way to alleviate fears (at least for medical researchers) is to perform a clinical trial. Thus a group from the University of Texas Southwestern Medical Center led by Dr. Lingvay set about performing the study. The results were published in this month's Diabetes Care. A total of 58 patients were recruited. All patients received a diagnosis of type 2 and were free of a long list of other confounding problems to make the data analysis easier. All patients received insulin plus metformin for 3 months. This was an important component of the study as one of the goals was to give all of the patients the experience of insulin shots before dividing up the group. After 3 months half the group was assigned to an oral hypoglycemic therapy consisting of metformin, glyburide, and pioglitazone. The other half remained on the insulin plus metformin regimen. All received diabetes and nutrition counseling. Patients were followed for 36 months.
As predicted, there were absolutely no differences between the groups in terms of glycosylated hemoglobin levels (Hemoglobin A1c), hypoglycemic episodes, or weight gain. While not statistically significant, it did look like the insulin treatment group lost a little weight and showed slightly better compliance than the metformin group. Interestingly, quality of life measures also showed no statistically significant differences. This would suggest that once the insulin treatment group got used to injections their quality of life was not worse. If it was, we would have seen a rise in quality of life for the oral hypoglycemic group once they stopped insulin injections. There was a slight increase in the perception of social stigma for the insulin treatment group as compared to the oral hypoglycemic group but again it was not statistically significant and it did not show up at all in the general measures of satisfaction.
The conclusion: we already know that insulin is cost effective and preserves beta cell function. There is no reason why it should not be considered as part of the first line treatment for the newly diagnosed type 2 diabetic.
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