Early Initiation of Insulin Shows Long-Term Benefit in Type 2 Diabetes

This article is written live from the American Association of Clinical Endocrinologists (AACE) 2017 Annual Meeting in Austin, TX. MPR will be reporting news on the latest findings from leading experts in endocrinology. Check back for more news from AACE 2017.

According to results of a retrospective analysis presented at the AACE 2017 Annual Meeting, initiating insulin within one year of a type 2 diabetes mellitus (T2DM) diagnosis improves a patient’s clinical profile and reduces total insulin dosage requirements, which in turn, can delay complications associated with the disease as well as decrease cost of treatment.

Study author Jothydev Kesadev, from Jothydev’s Diabetes & Research Centre, Trivandrum Kerala, India, described how “clinical inertia” among physicians and “psychological insulin resistance” among patients pose as the major factors preventing timely insulin initiation or intensification even when it is clinically appropriate.

To determine the benefits of early and aggressive intervention with insulin therapy, electronic medical records between January 2005 through January 2010 were utilized to identify patients with new onset T2DM (duration of disease of <1 year) who were subsequently initiated on insulin.

A total of 57 patients were included in the analysis. At baseline, patients in the study had an average HbA1c of 10.90±2.15%, an average fasting blood sugar (FBS) of 200.4±62.63mg/dL, an average post-prandial blood sugar (PPBS) of 348.0±139.3mg/dL, and an average body mass index (BMI) of 26.42±4.07kg/m². Additionally, the Total Daily Dose of Insulin (TDD) at baseline was reported as 21.67±14.61 U.

The study authors reported that the most recent data from October 2016 indicated significant improvements in all clinical parameters analyzed. At follow-up, the patients in the study had an average HbA1c of 7.56±1.91% (P<0.0001), an average FBS of 141.3±54.76mg/dL (P<0.0001), an average PPBS of 159.0±40.26mg/dL (P=0.0186), and an average BMI of 25.58±3.79kg/m² (P=0.0003). Analysis also showed that the TDD was found to be stable at 13.45±10.30 U (P=0.0664) and did not require increasing doses despite progression of disease.

This retrospective analysis demonstrated that early initiation of insulin is beneficial in patients with new onset T2DM. Kesadev concluded that, “it aided in improving the clinical parameters of the patients which in turn can delay the development of diabetes associated complications.” Study authors also added that, “the escalation required in TDD usually observed with progression of the disease could also be avoided with this early intervention of insulin therapy.”

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