Saturday, June 30, 2012

Preserve your Beta Cells, Its hard to find new ones

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.

Study design
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

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Your comments and questions are appreciated. David Calder,MD