A short course of intensive insulin therapy in certain patients with newly diagnosed type 2 diabetes may induce remission, a meta-analysis suggests.

The researchers looked for studies which assessed the use of insulin for two to three weeks, at diagnosis of type 2 diabetes, on ß-cell function and/or insulin resistance or assessed long-term drug-free remission.

Of 1,645 studies only seven, published between 2004 and 2012, covering 839 patients, met the inclusion criteria. Six of the studies were from China, the other from Taiwan. Mean baseline HbA1c was 9.7-11.9% and BMI 24.0-27.7kg/m².

Pooled analysis of the seven studies showed a 13% improvement in ß-cell function and a 43% decrease in insulin resistance, using modelling.

The investigators postulate that removal of glucose toxicity might improve ß-cell function and reduce insulin resistance.

Four studies assessed glycaemic remission. Two thirds of the patients (66.2%) treated with the regimen had achieved glycaemic remission at 3 months follow-up. Respective figures for remission at 6, 12 and 24 months follow-up were 58.9%, 46.3% and 42.1%.

Although interesting the meta-analysis is open to question. The number of studies eligible was small, and of the seven studies fitting the criteria five were not randomised. All the study subjects were Chinese, and type 2 diabetes in this ethnic group is characterised by a good response to acarbose and sulfonylureas, and low insulin requirements.

In an accompanying editorial, DeVries suggests that because of this the Chinese patients could be more likely to obtain remission from early insulin use than their Western counterparts.1 He also notes that there may be a Hawthorne effect: the subjects were more likely to adhere tightly to other aspects of lifestyle change because they were in a study.

The conclusion is that more studies are needed, with control groups and possibly across different ethnic groups, but at present there is no indication to deviate from existing guidelines. It may be that we will need to keep an open mind in the future about the timing of the use of insulin.

Dr Matthew Lockyer