Diabetes Care - July 2012 volume 35 Page 1406-1412
Beta cell Function Preserved after 3.5 years of intensive Diabetes Therapy
This study demonstrates Beta cell function can be preserved with early aggressive therapy for patients with type 2 Diabetes
Current approaches to Diabetes management usually go in a step wise method starting with one drug metformin and then adding other medications as needed depending on the progression of the disease.This approach leads to some thing called treatment inertia and a continuous progression of Beta cell failure. The progressive Beta Cell failure was best demonstrated in a classic study, UK Prospective Study ( UKPDS ) , one of the first studies to demonstrate that achieving an A1c of 7 reduced the risk of developing Eye , nerve and kidney damage.
Patients were 21 to 70 years old treatment Naive type 2 Diabetes diagnosed within the previous 2 months.
All patients were initially treated with metformin and insulin ( Novolog mix/ their protocal )for 3 months and then divided into 2 groups and followed for 3.5 years
Group 1 continue Metformin and Insulin
Group 2 switched to Triple therapy Metformin , Glyburide and pioglitzone
The medications in both groups were adjusted to attain excellent A1c results
Group 1 average A1c 6.3 at the end of the study
Group 2 average A1c 6.59 at the end of the study
Beta cell function was preserved for 3.5 years in both groups
This study demonstrated that intensive therapy with insulin and metformin at the time of diagnosis of Type 2 Diabetes followed by multiple oral agents or insulin can preserve Beta cell function. Treatment inertia fostered by by the stepwise approach to glucose control may not be the best thing for your Beta cells.
Have fun , Be smart , Avoid treatment inertia and preserve your Beta Cells
David Calder, MD