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Insulin for Early Type 2 Diabetes?

Study Suggests It Helps Patients Maintain Metabolic Control
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WebMD Health News

Aug. 21, 2003 - Insulin is widely thought of as a treatment of last resort for patients with type 2 diabetes, but new research may help change that thinking. Early insulin therapy resulted in better control than that seen with oral medications in a new study done in Sweden.

Researchers suggest that early insulin therapy can help patients maintain the ability to produce their own insulin longer. In addition, early insulin therapy is not associated with hypoglycemia or weight gain and does not negatively affect volunteers' cholesterol levels, researchers say. These are all common reasons doctors delay prescribing insulin therapy.

Researcher Michael Alvarsson, MD, PhD, says the message is not that all, or even most, people with type 2 diabetes should be on insulin from the start, but that doctors should not delay giving insulin to patients who may need it. Endocrinologist Nathaniel Clark, MD, of the American Diabetes Association (ADA), agrees.

"Insulin is simply another treatment for type 2 diabetes, and, like other treatments, it has its pluses and its minuses," Clark tells WebMD. "But, unfortunately, clinicians tend to see it as the treatment they turn to when oral medications have failed, so it is no surprise that patients fear it."

The two-year Swedish study included 39 adults newly diagnosed with type 2 diabetes. They were randomly assigned to treatment with either twice-daily injections of insulin or a widely prescribed oral drug called a sulfonylurea.

After a year of treatment, the patients who had taken insulin were better able to produce their own insulin than those taking the oral medication. The ability to produce insulin was similar in the two groups after two years of treatment, but the insulin-treated group had better blood sugar control, Alvarsson tells WebMD. And the patients on insulin therapy experienced none of the side effects that have been linked to its use, such as weight gain and elevated cholesterol.

The findings are published in the August issue of the ADA publication Diabetes Care.

"Our findings need to be confirmed, but they suggest that early insulin treatment can result in better metabolic control," Alvarsson says. "Overall, I think clinicians are too reluctant to give this treatment to patients with early disease."

Diabetes specialist Allison Goldfine, MD, tells WebMD that the epidemic of type 2 diabetes has intensified the search for effective ways of delaying disease progression. The disease is no longer confined to patients who are middle aged and older, but is now commonly seen among young adults, teens, and even children as the epidemic of obesity extends to this age group. Goldfine is an assistant professor at Harvard Medical School and an investigator with the Joslin Diabetes Center.

"These days, it's not uncommon for me to look across my desk and see a patient who is in high school," Goldfine tells WebMD. "We are talking about patients who are going to need treatment for 50 years or so. With this in mind, therapies that actually preserve metabolic function longer are likely to be increasingly important because preserving metabolic control may protect against the long-term, devastating complications of diabetes."

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