Whether to take insulin for type 2 diabetes is not only confusing for patients and friends, but also has been controversial in academic circles. In recent years, extensive research has been conducted on the indications, timing and pros and cons of insulin therapy in type 2 diabetes, and the following is the understanding and knowledge of early intensive insulin therapy in type 2 diabetes.
As an important branch of research on islet function protection in type 2 diabetes, the islet-protective effect of intensive early glycemic control in type 2 diabetes has been confirmed by several domestic and international clinical studies. The selection of indications for intensive therapy is important, and the clinical characteristics that have reached consensus are fasting glucose ≥ 11.1 mmol/L in patients with type 2 diabetes and a disease duration of generally less than one year. Early receipt of short-term intensive insulin therapy significantly improves β-cell function (especially first-phase secretion) and induces a long-term drug-free remission period.
Moreover, short-term intensive therapy does not cause weight gain and no serious hypoglycemic reactions, which can lay the foundation for long-term good glycemic control relatively safely and effectively. Patients with contraindications to intensive therapy (e.g., propensity to hypoglycemia, cardiovascular disease and serious complications) should avoid this treatment modality as much as possible.
There is no consensus on the duration of intensive therapy, but long-term intensive insulin therapy is not recommended for patients with newly diagnosed type 2 diabetes because the negative effects of insulin therapy (e.g., hypoglycemia, weight gain) will become apparent at this time. This is especially true for diabetic patients who are significantly obese.
Research data show that for patients with fasting glucose ≤11.1 mmol/L at the onset of the disease, conventional oral medication can also achieve good glycemic control and thus better β-cell function, and about 1/3 of patients can maintain clinical remission for more than 1 year after stopping the medication. Obviously, this ratio is significantly lower than that of the insulin treatment group, but what cannot be ignored is the compliance and simplicity of oral drug therapy. With the introduction of a variety of new drugs with potential β-cell protective effects, the connotation and options of oral drug therapy have been greatly expanded.
The choice of treatment strategy for patients at this glycemic level deserves further exploration. It is worth noting that no matter what treatment mode is used, patients should maintain a good lifestyle and dietary control is particularly important, while insulin use skills should be improved and diabetes education should be enhanced in order to effectively respond to common adverse effects of insulin therapy such as hypoglycemia and weight gain. Otherwise, any intensive treatment is unlikely to achieve the desired goals.
In conclusion, the clinical effect of intensive insulin therapy for newly diagnosed type 2 diabetes mellitus is clear, and it is a promising treatment modality worth trying. However, it is very important to master the indications and contraindications of intensive insulin therapy, and careful observation of patients’ blood glucose and weight changes, together with fine glycemic regulation, is necessary for clinical benefit.