Type 2: Early Therapy Helps Retain Beta Cell Function

Immediately starting intense therapy for newly diagnosed type 2s preserved their beta cell functioning for 3.5 years, according to a University of Texas Southwestern Medical Center study.

The researchers started with 67 patients who had never received medication specifically aimed at treating diabetes. The patients, all adults, averaged 45 years of age and were all members of non-white ethnic minorities. They had an average body mass index of 36 (obese) and an average A1C of 10.6%.

Of the initial group, 58 finished a three-month pre-study in which they received a combination insulin/metformin therapy. The pre-study doses of insulin and metformin were intended to ease the effects of glucotoxicity on the patients’ beta cells and prepare them for the subsequent experiment. (Glucotoxicity occurs when high blood sugar levels damage the insulin-producing beta cells in the pancreas.)

At the end of the pre-study, the patients were divided into two groups: One continued receiving the insulin/metformin combination, while the second received a triple oral drug therapy that consisted of 1.25 mg of glyburide (a sulfonylurea) twice daily, 1,000 mg of metformin twice daily, and pioglitazone (brand name Actos).

Treatment success was defined as an A1C below 8%. By the end of the three-month pre-study, the patients’ average A1C had dropped to 5.9%, and all participants were at or below the ADA-recommended target of 7%.

Researchers noted that the dramatic improvement in the patients’ A1C levels over the three-month pre-study period was sustained through the study itself. In fact, their beta cells continued to function at a high level for an average of 3.5 years. Both the group receiving insulin-based therapy and the group receiving the triple oral therapy had the same results.

The Texas scientists, headed by Ildiko Lingvay, MD, assistant professor of internal medicine at University of Texas Southwestern Medical Center, concluded that medical practitioners should not wait for high A1C levels to justify intensive therapy, but should attempt to achieve glycemic normalization as soon as possible in newly diagnosed type 2 patients.

Dr. Lingvay said that she does not think that monotherapy is sufficient to affect the progression of the disease. She added that even the intensive therapy tested by her and her colleagues can only slow, not prevent, the eventual weakening and loss of beta cell function.