Early Insulin Therapy Improves Type 2 Diabetes Care

This article is part of Endocrinology Advisor‘s coverage of the 26th American Association of Clinical Endocrinologists (AACE) Annual Scientific Sessions & Clinical Congress, taking place in Austin, Texas. Our staff will report on medical research and technological advances in diabetes, obesity, and thyroid conditions, conducted by experts in the field. Check back regularly for more news from AACE 2017.

New research confirming the benefits of early initiation of insulin in patients with type 2 diabetes was presented at the 26th American Association of Clinical Endocrinologists (AACE) Annual Scientific Sessions & Clinical Congress, May 3-7, in Austin, Texas.¹

Despite evidence that early insulin initiation can reduce the risk for complications such as cardiovascular events in patients with type 2 diabetes, barriers to its implementation remain.² Clinical inertia among healthcare providers and patients’ opposition to insulin therapy, dubbed “psychological insulin resistance,” are 2 major obstacles to timely initiation or intensification.

Some findings indicate that insulin is often initiated in these patients only after several trials of oral antidiabetic drugs, and at a point when glycated hemoglobin (HbA1c) levels significantly exceed guideline recommendations.²

The current investigators conducted a retrospective analysis to further elucidate the benefits of early insulin initiation in this patient population. The sample included 57 individuals with new-onset type 2 diabetes who were initiated on insulin therapy at a diabetes center in India between 2005 and 2010. Follow-up data were available as recently as 2016.

The results showed significant improvement from baseline to follow-up in mean levels of the following clinical parameters.

• Baseline HbA1c: 10.90%±2.15%

• Follow-up HbA1c: 7.56%±1.91% (P <.0001)

• Baseline fasting blood sugar: 200.4±62.63 mg/dL

• Follow-up fasting blood sugar: 141.3±54.76 mg/dL (P <.0001)

• Baseline postprandial blood sugar: 348.0±139.3 mg/dL

• Follow-up postprandial blood sugar: 159.0±40.26 mg/dL (P =.0186)

• Baseline body mass index: 26.42±4.07 kg/m²

• Follow-up body mass index: 25.58±3.79 kg/m² (P =.0003)

In addition, the total daily dose of required insulin remained stable from baseline (21.67±14.61 U) through follow-up (13.45±10.30 U; P =.0664), suggesting early initiation may prevent the dosage escalation that is typically required as the disease progresses.

“Early insulin initiation in eligible candidates with [type 2 diabetes] lays a very strong foundation for future diabetes care,” the researchers wrote. This strategy “improves their clinical profile thereby delaying the onset of complications along with lower requirement of total insulin dosages which in turn will significantly bring down the cost of diabetes treatment.”

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Reference

1. Kesavadev J, Joshi S, Saboo B, et al. Improved short term and long term outcomes of early insulin initiation in type 2 diabetes over 10 years. Abstract 238. Presented at: 26th American Association of Clinical Endocrinologists (AACE) Annual Scientific Sessions & Clinical Congress. May 3-7, 2017; Austin, TX.
2. Khunti K, Millar-Jones D. Clinical inertia to insulin initiation and intensification in the UK: a focused literature review. Prim Care Diabetes. 2017;11(1):3-12. doi:10.1016/j.pcd.2016.09.003