Hit that "Pause" button in Type 2 Diabetes

Ever wondered if one could actually do away with medicines in Type 2 Diabetes or at least some way to "pause" the disease, the following study in The Lancet this week is promising.
UKPDS showed that Type 2 diabetics had 50% loss of Beta cell function at diagnosis and kept deteriorating over time. Researchers were in active search for therapeutic interventions which can prolong beta cell life. Some drugs which have shown benefit in this aspect although in animal studies are the Incretins. Thiazolidenediones are also known to preserve or improve beta cell function. Some studies have shown short term intensive glycemic control can induce remission of type 2 Diabetes for some time.

The following is a study conducted in China in Type 2 Diabetics which was designed to assess the efficacy of short term intensive therapy(Insulin or oral agents) to induce remission of Type 2 Diabetes.

• 436 patients - newly diagnosed Type 2 Diabetics
• FPG level 126-300 mg/dl
• Excluded were those with acute or severe diabetic complications, intercurrent illness, positive GAD antibody
• 3 arms - Multiple dose Insulin(MDI) arm, Continuous subcutaneous insulin(CSII) arm, Oral agents arm( either Gliclazide, Metformin or both)
• Doses titrated to achieve FPG less than 110 and Post meal less than 140
• After achieving above targets Rx was continued for 2 weeks
• After interventions were stopped, patients were instructed to continue diet and physical exercise only and were followed-up with glycaemic monitoring monthly during the initial 3 months and at 3-month intervals thereafter.
• Hyperglycaemia relapse was defined as either fasting plasma glucose of more than 7·0 mmol/L or 2-h postprandial plasma glucose of more than 10·0 mmol/L, which was confirmed 1 week later.
• Remission group - those who maintained glycemic control for 12 months without medication.
• 45% of patients who received insulin treatment (CSII or MDI) and 25% of patients treated with oral hypoglycaemic agents achieved long-lasting remission.

In patients newly diagnosed with type 2 diabetes, any kind of early intensive glycaemic control—either induced by insulin or oral hypoglycaemic agents—could rescue β-cell function and induce longterm glycaemic remission in almost half of patients, most likely through eliminating the effects of acute glucotoxicity and related pathogenesis factors. - Weng et al

Original Article in The Lancet here