Diabetes Patients May Have Wrong Idea About Taking
Insulin: Should be Front-Line Defense
Common fears of
weight gain, developing low blood-sugar, decline in quality of life are
largely unfounded, researchers find
Research by Dr.
Ildiko Lingvay (left) and others has shown that the more than 20 million
Americans with type 2 diabetes, like Soila Canales, should consider
insulin as a front-line defense.
Aug. 11, 2009 - People diagnosed with type 2
diabetes including millions of senior citizens - often resist taking
insulin because they fear gaining weight, developing low blood sugar and
seeing their quality of life decline. A study recently completed at UT Southwestern
Medical Center suggests that those fears are largely unfounded and that
patients and physicians should consider insulin as a front-line defense,
as opposed to a treatment of last resort for non-insulin-dependent
diabetes.
We found that those patients who received insulin
initially did just as well, if not better, than those who didnt receive
insulin, said
Dr. Ildiko Lingvay, assistant professor of internal medicine at UT
Southwestern and lead author of the study appearing online and in a
future issue of Diabetes Care. This reinforces the idea that insulin
treatment is a viable and safe option for patients, even in the very
initial stages of their diagnoses.
Study of seniors finds physical activity, good
dietary habits, not smoking and light alcohol use lowers diabetes risk
by 82%; four in five new cases attributable to not having these low-risk
factors.
There is a myth out in the community, especially
among certain ethnicities, that insulin is the last resort, and that
somebody started on insulin is going to die, Dr. Lingvay added. We as
physicians are responsible for teaching the patient that thats not the
case.
More than 20 million Americans have type 2
diabetes. Obesity, age and lack of exercise all increase the risk for
the disease, which is characterized by a progressive loss of
insulin-producing beta cells. Diabetes is the single greatest
independent risk factor for heart disease, as well as a contributor to a
number of other medical problems, including blindness and kidney
disease.
The standard initial treatment for type 2 diabetes
is a single drug, often metformin, followed by the addition of more oral
hypoglycemic agents as needed.
For this study, researchers evaluated the
effectiveness of offering insulin-based therapy as an initial treatment
option to newly diagnosed type 2 diabetes patients. They compared rates
of compliance, satisfaction, effectiveness, safety and quality of life
among the patients, who were randomized to receive either the standard
triple oral therapy or insulin plus metformin, an oral drug that helps
regulate blood sugar levels.
The patients, ranging in age from 21 to 70 years
old, had been diagnosed with type 2 diabetes within the past two months.
Researchers recruited study participants from Parkland Memorial Hospital
or by self-referral to the Clinical Diabetes Research Clinic at UT
Southwestern between November 2003 and June 2005.
After enrollment, every participant followed an
insulin and metformin regimen for three months. The patients were then
randomized to continue taking insulin and metformin or begin the triple
oral therapy regimen. All participants were checked monthly for the
first four months, at six months after randomization, and every three
months thereafter for three years. Of the 58 patients randomized, 24 of
the insulin-treated group and 21 of the triple oral therapy group
completed the study.
The researchers found that the patients taking
insulin plus metformin had fewer low-blood-sugar, or hypoglycemic,
events, gained less weight and reported high satisfaction with the
insulin.
Dr. Lingvay said she hopes physicians use these
findings as the rationale to offer insulin-metformin as the first,
rather than last, line of defense.
Modern medicine uses insulin as a very effective
and safe treatment tool, she said. With the new devices that were
using, giving yourself an insulin shot is not much harder than taking
pills.
The data represent the first three years of a
six-year study still under way at UT Southwestern. The next step, Dr.
Lingvay said, is to begin analyzing how the insulin plus metformin and
oral triple therapy regimens affect insulin production in beta cells.
Other UT Southwestern researchers involved in the
study included Jaime Legendre, recipient of a Clinical Research
Fellowship from the Doris Duke Charitable Foundation; Dr. Polina
Kaloyanova, former fellow in endocrinology;
Dr. Song Zhang, assistant professor of clinical sciences; and
Beverley Adams Huet, assistant professor of clinical sciences.
The study was supported by Novo Nordisk Inc., the
National Institutes of Health and the Doris Duke Charitable Foundation.
The standard initial treatment for type 2 diabetes
is a single drug, often metformin, followed by the addition of more oral
hypoglycemic agents as needed.