Early Initiation of Insulin Therapy in Newly Diagnosed Patients with Type 2 Diabetes and Exploring the Legacy Effect—A Single-arm Prospective Observational Study

Abstract

A bstrAct Background: Early insulin has the potential to not only provide glycemic benefit and β-cell salvage but also reduce microvascular and macrovascular complications. Several reports have shown that the short-term intensive insulin therapy can induce long-term glycemic control in newly diagnosed type 2 diabetes mellitus (T2DM) patients with mild to moderate hyperglycemia. Thus, we hypothesize that a 2-month intensive glycemic control using glargine in newly diagnosed T2DM patients will provide glycemic and legacy benefit. Objective: To assess whether 2-month treatment with insulin in newly diagnosed T2DM patients (HbA1c > 9%) brings about long-term glycemic control even after stopping insulin after 2 months and also reduction in requirement of other antidiabetic agents. Method: A prospective single-arm observational study included subjects initiated on insulin, which was stopped after 2 months and lifestyle modification was advised along with oral antidiabetes drugs thereafter. For the initial 2 months, the patients were reviewed weekly and fasting capillary blood glucose was aimed to be maintained between 80 and 130 mg/dL. The included subjects were followed up every 3 months, for a period of 1 year for glycemic parameters. Results: The study included patients who demonstrated intensive glycemic control with early insulin use. These patients who were followed up over a year in interval of 3 months demonstrated a steep reduction in glycemic indices with time. A steady reduction in mean antidiabetic medications in the subjects was seen over the time period. Conclusion: Early insulin initiation may result in long-term benefits. Optimum glycemic control in the early stage of diabetes using insulin provides legacy effects and good metabolic memory.