Short-Term Effects of Basal-Plus Insulin Therapy on Early Remission of Newly Diagnosed Type 2 Diabetes

Objective: Ketosis prone diabetes has been associated with prolonged normoglycemic remission after discontinuation of early intensive insulin therapy. However, it is unknown if such an approach can produce similar results in classical type 2 diabetes (T2DM). Therefore, our study sought to assess the effects of an outpatient regimen of basal-plus insulin therapy on early remission of newly diagnosed T2DM.

Research Methods: Newly diagnosed T2DM patients had an 8-week course of basal-plus insulin therapy which was then discontinued. Weekly 4-point glycemic profiles were done. HbA1c, lipid profile and insulin sensitivity, using the hyperinsulinemic euglycemic clamp were assessed at baseline and after the intervention. Early remission was defined as HbA1c < 48mmol / mol without treatment for at least 12 weeks

Results: Eleven patients were included on diagnosis. Fasting blood glucose decreased (12.7 [7.8-15.0] vs. 4.9 [4.2-6.2] mmol / l). HbA1c dropped from 101.0 [84.0 -108.0] to 42.0 [36.0-50.0] mmol / mol, after basal-plus insulin therapy and was maintained at 38.0 [33.0-43.0] mmol / mol after 12 weeks with no active treatment. Ten out of eleven subjects experienced early remission. Insulin sensitivity improved significantly after the intervention with a variation in the adjusted M-value from 7.95 [6.39-11.03] to 12.85 [10.24-14.92] mg / kg / min,. The distinctive feature of those who did not require antidiabetic medications was that their initial standardized M-value was > 5.0 mg / kg / min. A significant decrease in total cholesterol and LDLc was observed from 5.40 [5.17-5.87] to 4.45 [3.57-5.48] mmol / L, and 3.83 [2.82-4.37] to 1.[0.54-2.95] mmol / L, respectively. HDLc increased significantly from 1.14 [1.03-1.40] to 2.12 [1.86-2.69] mmol / L.

Conclusion: Basal-plus insulin therapy is effective, feasible, and safe in newly diagnosed T2DM and can induce early remission as observed in ketosis prone diabetes.