Eugene C. Corbett, Jr., MD
In patients with newly diagnosed type 2 diabetes mellitus, does intensive insulin therapy improve glycemic control and remission rates more than oral hypoglycemic agents (OHAs)?
Randomized controlled trial.
9 centers in China.
410 patients who were 25 to 70 years of age, had newly diagnosed type 2 diabetes according to World Health Organization criteria (1999), had fasting plasma glucose levels between 7.0 mmol/L (126 mg/dL) and 16.7 mmol/L (300 mg/dL), and had not received antihyperglycemic therapy. Exclusion criteria were acute or severe diabetic complications, severe comorbid illness, positive test result for glutamic acid decarboxylase antibody, maturity-onset diabetes in youth, or mitochondria diabetes mellitus. 382 patients (mean age 51 y, mean body mass index 25 kg/m2) received interventions.
Patients were allocated to intensive insulin therapy given as a continuous subcutaneous infusion (CSII) (n = 137) or as multiple daily injections (MDII) (n = 124), or to OHAs (n = 121). The CSII group received human insulin with an insulin pump. The MDII group received premeal Novolin-R and human insulin NPH at bedtime. Initial insulin doses were 0.4 to 0.5 IU/kg. The OHA group received gliclazide, 80 mg twice daily (increased to maximum of 160 mg twice daily), if body mass index (BMI) was between 20 and 25 kg/m2, or metformin, 0.5 g twice daily (increased to maximum of 2.0 g/d), if BMI was between 25 and 35 kg/m2. Treatment was stopped after normoglycemia was maintained for 2 weeks; patients were then instructed to continue diet and physical exercise only.
Time to initial glycemic control and remission at 1 year among the 352 patients (64% men) who achieved initial glycemic control.
81% completed the study.
Time to glycemic control was shorter in the CSII (4.0 d, P <0.0001) and MDII (5.6 d, P = 0.01) groups than in the OHA (9.3 d) group. Remission rates at 1 year were higher in the intensive-insulin groups than in the OHA group (Table).
In patients with newly diagnosed type 2 diabetes mellitus, intensive insulin therapy reduced time to glycemic control and had a higher remission rate than oral hypoglycemic agents.
Continuous subcutaneous insulin infusion (CSII) or multiple daily insulin injections (MDII) vs oral hypoglycemic agents (OHA) in newly diagnosed type 2 diabetes mellitus†
†Abbreviations defined in glossary. RBI, NNT, and CI calculated from data in article.
Corbett EC. Intensive insulin therapy improved glycemic control more than oral hypoglycemic agents in newly diagnosed type 2 diabetes. Ann Intern Med. 2008;149:JC3–5. doi: 10.7326/0003-4819-149-6-200809160-02005
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Published: Ann Intern Med. 2008;149(6):JC3-5.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism.
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