Its said glucose toxicity significantly affects beta cell function in the early part of type 2 diabetes and hence giving insulin for 3 months and reduce glucose toxicity and give rest to beta cells is going to be the treatment of choice. Its an important lecture delivered by a diabetologist at ACP india National conference on 5-6 Sept 2014 at New Delhi.
I don't think it is a question of "better" but rather a viable alternative. All international guidelines recommend metformin as initial therapy, but do give insulin as an alternative. As you must be aware, there are a number of publications suggesting early insulin therapy may preserve beta cell function, but the question is - for how long? Most of the studies showing a beneficial effect on beta cell function of early insulin as first line therapy come from China, and the point has been raised that there may be a subtle difference in the pathophysiology between Chinese and Western cohorts. Certainly, the ORIGIN study did show a 28% reduction in conversion from IGT to frank diabetes in subjects on glargine insulin, but this effect waned fairly quickly and in a short time most of the subjects who were prevented from going onto diabetes at the end of the study became diabetic.
Early insulin may even place some patients in short-term "remission" but eventually the diabetes will return and require therapy with Oral Agents (or insulin again) and we should ask whether it is a worthwhile long-term (as opposed to short term) option.
Although insulin supplementation is a viable option, one needs to understand the effect of insulin at a molecular level. The use of insulin is most effective, when the normal physiological mechanisms fail. If you give supplement insulin, will it further contribute to insulin resistance; insulin receptor desensitization? This is a very important question to be considered. Will the rate of remission may increase, or the progression of insulin resistance may be speed up? Using other alternatives to reducing glucose load, such as Acarbose (which has been flagged as less effective.) but I beg to reconsider and DPP-4 inhibitors, very tight dieting control maybe a viable option as well. This is my contribution, but it is something to consider, when evaluating the Pros' vs the Cons'
From what I understand, unless the underlying causes of need for more than normal amounts of insulin to achieve euglycemia are addressed, in the long run, not much is going to be helpful in changing the outcome. As pointed out above, it is just a matter of some delay in clinically recognizable full-blown type 2 diabetes.
http://www.hindawi.com/journals/omcl/aip/6978625/
Dual therapy with metformin and insulin promotes more benefits to oxidative stress control in muscle of hypoinsulinemic rats than insulinotherapy alone.
- Badges
- Science topic
- Similar topics
- Medicine
- Disease
- Metabolic Diseases
- Glucose Metabolism Disorders
- Diabetes