Treating Diabetes Early, Intensively Is Best Strategy

Intensive early treatment of type 2 diabetes slows down progression of the disease by preserving the body’s insulin-producing capacity, a UT Southwestern study has shown.

“We can potentially change the course of this prevalent disease, which would represent a breakthrough,” says Ildiko Lingvay, MD, an assistant professor of internal medicine and author of the study published online in Diabetes Care. “The intensive treatment regimen we propose is different from the stepwise approach recommended in standard guidelines.”

While intensive treatment has been the standard at UT Southwestern for at least a decade, the industry norm has been to emphasize lifestyle changes first. The American College of Physicians, for example, suggests losing weight and dieting before drug treatment. The American Diebetic Association recommends similar lifestyle changes, plus the use of metformin for those newly diagnosed.

“We believe that the stepwise approach exposes patients to long periods of high blood sugar, which leads to complications,” Lingvay says. “Unless dietary changes are significant and sustained long-term, diabetes is a progressive disease in which the body’s ability to produce insulin declines.”

If a patient can maintain insulin production, she explains, the disease is easier to manage. The study showed intensive treatment with insulin, followed by one of two drug regimens, enabled diabetes patients to maintain steady insulin-producing beta-cell function for three and a half years after diagnosis.

“This finding was true, regardless of the method used to attain intensive control,” Lingvay says. “Intensive treatments led to excellent control of blood-sugar levels, they were well-tolerated, safe, and had good compliance.”

In the UT Southwestern clinical trial, participants were randomly divided into two groups. Both groups first had three months of treatment with insulin and the antidiabetes drug metformin. After that, one group took three types of diabetes medications daily, while the other continued the insulin and metformin treatment. Out of 63 initial trial recruits, 58 completed the study and are still being tracked for six-year results.

Lingvay says the study did not show that any single regimen worked better than another; both intensive treatment regimens were just as effective.

“The point is that whatever you choose, make sure it’s intensive,” she says. “We have shown that this preserves beta-cell function, and that’s the key in changing the course of the disease.”

Source: UT Southwestern Medical Center