We thank Yoshioka, Yoshida, and Yoshikawa (1) for their interest and comments on our article (2) on the use of a short course of intensive insulin therapy in newly diagnosed type 2 diabetic patients. We are pleased that they think this strategy has merit. Our study was an initial pilot study and did not include detailed measures of insulin sensitivity, and we acknowledge this in the article.

Yoshioka, Yoshida, and Yoshikawa make the point that insulin secretion increased equally in both the diet-responsive group and those needing oral hypoglycemic agents (OHAs) or insulin. There was a higher basal insulin-to-glucose ratio in the diet-failure group at the end of the short course of insulin therapy, suggesting more insulin resistance. They consider that insulin resistance, rather than insulin secretory defects, influences the need for OHAs or insulin after a short course of insulin treatment in newly diagnosed type 2 diabetic subjects.

We agree that less insulin resistance was a better predictor of longer-term success on diet alone and made this point in our discussion of the results when we state that those who normalized their glucose more readily with less insulin are, by definition, more insulin sensitive and “this may be an underlying contributor to their longer-term success.” We also point out that the difference in the insulin-to-glucose ratio after the course of insulin therapy did not reach statistical significance. The homeostatis model assessment of insulin sensitivity (3) after the course of insulin therapy was significantly higher in the diet-only group (86.4 ± 12.2%) than in the OHA/insulin group (50.2 ± 6.3%, P = 0.014). It should be recalled that in posttherapy, the exogenous insulin was held the night before the test but the recently prior exogenous insulin may interfere with the model assessment. Irrespective of these tests, we feel that the better response to insulin in the diet-only group demonstrates a priori increased insulin sensitivity. As we noted in the discussion, an unknown is the duration of the diabetes prediagnosis, which may be important.

We agree that insulin sensitivity is an important determinant of the longer-term success demonstrated. However, given the further increase in insulin area under the curve at 1 year in both groups, it is clear that insulin secretion had not reached its maximum potential and thus the insulin secretory defect is important. We concur that the area is deserving of further study.

1.
Yoshioka K, Yoshida T, Yoshikawa T: Short-term intensive insulin therapy in newly diagnosed type 2 diabetes (Letter).
Diabetes Care
27
:
2281
–2282,
2004
2.
Ryan EA, Imes S, Wallace C: Short-term intensive insulin therapy in newly diagnosed type 2 diabetes.
Diabetes Care
27
:
1028
–1032,
2004
3.
Levy JC, Mathews DR, Hermans MP: Correct homeostasis model assessment (HOMA) evaluation uses the computer program (Letter).
Diabetes Care
21
:
2191
–2192,
1998