With Type-2 diabetes, the body’s ability to produce needed insulin declines. Doctors often recommend lifestyle changes and the drug metformin after an early diagnosis. But an eight year study by U.T. Southwestern Medical Center has found early intensive treatment of insulin and a drug regimen may be a better strategy. In a KERA Health Checkup, the author of the study, Dr. Ildiko Lingvay, talks about the results.
Dr. Lingvay: When we treated our patients with intensive therapy for Type 2 diabetes, early after the diagnosis of diabetes, we were able to change the natural progression of the disease where the insulin levels remained the same throughout the course of the follow-up, which was three and a half years. We would normally expect, with the natural progress of the disease, to see a progressive decline over time and this has been well documented in over time in previous studies.
Sam: With Type 2 diabetes, at least what the American College of Physicians recommends is, really, just a lifestyle change: diet and exercise. What was it that suggested that this approach didn’t work or didn’t work as effectively?
Dr. Lingvay: Lifestyle works very well. It’s an excellent preventive measure for diabetes, and it’s excellent to continue even after you’re diagnosed with diabetes. But part of the reason these patients have diabetes is that they have not been able to successfully comply with all the changes that are required to lose weight and eat healthy.
Sam: Meaning if you had been following diet and exercise well all along you wouldn’t have developed Type 2 Diabetes to begin with?
Dr. Lingvay: That’s correct. And I’m not saying that’s not worth continuing…
Sam: Even with the intensive treatment?
Dr. Lingvay: Even with the intensive treatment and for the entire duration of the disease. But I think that’s not enough. Treating diabetes early and treating it intensively is what we feel like it has a chance to change the course of the disease.
Sam: Did this work for everyone you tried this approach with?
Dr. Lingvay: We had less than a ten percent failure rate. Generally speaking, these were patients who weren’t taking all their medications all the time. Compliance plays a big factor in diabetes treatment. But probably biology of the disease plays a role.
Sam: Why hasn’t this approach been taken before?
Dr. Lingvay: There is insulin resistance. People think that this is hard to do. Doctors think that the patients don’t want to do it. Patients sometimes are misled by family members or by experiences they have had in the past from their own family or friends. And they also associate it with an end of life event. They all might have had a neighbor or an aunt that was started on insulin and died two months later. Insulin is not a marker of the end of the disease. Insulin is a treatment that can be employed at any point during the diabetes continuum, and it’s actually better if you use it earlier because it’s the most effective and the safest treatment for diabetes. The problem is we have been using it as a last resort, and therefore it’s associated in lots of our patients’ minds with end-stage disease or with death.
Sam: What are the implications for the results of this study?
Dr. Lingvay: No other treatment combination that we have studied to date was able to show that we can change the course, the natural progression of the disease. So, in that sense, this is a breakthrough. And while confirmation and using treatment strategies that incorporate a newer medication would be the next step of evaluation, I think this is a very important step toward a different sort of therapy for Type 2 diabetes.
Dr. Ildiko Lingvay is an assistant professor of internal medicine at U.T. Southwestern Medical Center.
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