This week the Lancet is a themed issue with several articles covering diabetes diagnosis and care.
One of the articles reveals the results of a study that examined early intensive insulin therapy in patients with newly diagnosed type 2 diabetes. This study has been reported in the general media (BBC).
382 Chinese patients aged 25 to 70 years old with fasting glucose greater than 7mmol/L were randomised to treatment with insulin (infusion or injection) or oral therapy. Treatment was continued for two weeks after normoglycaemia was achieved and then stopped, follow up with diet and exercise continued. A greater proportion of patient in the insulin arms achieved target glycaemic control and sooner.
- Insulin infusion - 97.1% achieved control in a mean of 4 days (SD 2.5 days)
- Insulin injections - 95.2% achieved control in a mean of 5.6 days (SD 3.8 days)
- Oral therapy - 83.5% achieved control in a mean of 9.3 days (SD 5.3 days)
Additionally, it seems that glycaemic remission was significantly higher in the groups who were randomised to insulin with 51.1% and 44.9% remaining in remission of diabetes compared to 26.7% of the patients randomised to oral therapy (p= 0.0012). Although the results of this study are interesting the study was small therefore more research is required before change in practices can be recommended.
A second study of lifestyle interventions reviewed 20 year data for 577 adults with impaired glucose tolerance who were randomised to a control group or an intervention group for diet, exercise or both. Active interventions were continued over a 6 year period.
Patients in the combined intervention arm had 51% lower incidence of diabetes during the active phase and this continued with a 43% lower incidence over 20 years.
This study concludes that, "lifestyle interventions over 6 years can prevent or delay diabetes".
Action: Clinicians should already be aware of the importance lifestyle interventions for patients with diabetes. Media coverage of the study involving intensive insulin therapy early in diabetes may generate queries but this strategy should be researched more fully before being adopted into clinical practice.