Objective: To assess the efficacy of short-term insulin therapy compared with exenatide treatment on glycemic control, beta-cell function, insulin sensitivity, and long-term glycemic control in newly diagnosed type 2 diabetic patients with severe hyperglycemia.

Methods: Newly diagnosed type 2 diabetic patients with HbA1c above 9% were treated with intensive insulin injection for 10-14 days in the hospital or outpatient clinic. The oral glucose tolerance test (OGTT) was performed after intensive insulin treatment. After the OGTT, the patients were randomized to receive either insulin therapy (NPH injection twice daily) or exenatide therapy (exenatide injection twice daily) for further 4 months. The patients started to take oral antidiabetes drugs after 4 months of randomization. The OGTT was repeated 6 months after randomization to evaluateβ-cell function and insulin sensitivity again. The subjects were continually followed up for another 1 year to evaluate long-term glycemic control.

Results: We recruited 44 patients and 40 patients were randomized to insulin group (n = 22) and exenatide group (n = 18). The HbA1c level between insulin group and exenatide group at 6th month (6.74 ± 1.12% vs. 6.88 ± 0.76%; P = 0.681) and 18th month (6.60 ± 0.92% vs. 7.13 ± 0.83%; P = 0.093) of the study showed comparable results. The glucose area under the curve, insulinogenic index, and total insulin secretion improved significantly in both groups after 4 months of treatment. Compared with the exenatide group, the homeostasis model assessment of β-cell function index, insulinogenic index, and total insulin secretion were better in the insulin group.

Conclusions: A 4-month course of both the insulin and exenatide treatment could achieve good glycemic control in newly diagnosed type 2 diabetes with severe hyperglycemia. However, the insulin treatment could improve more β-cell function than exenatide therapy.


T. Wu: None. H. Chen: None.

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