No Need for the Needle (at First)

Abstract

In this issue of Diabetes Care , Chen et al. (1) describe an approach to the initial treatment of newly diagnosed type 2 diabetic patients with severe hyperglycemia (fasting plasma glucose [FPG] concentrations >300 mg/dl or random plasma glucose concentrations >400 mg/dl) entailing intensive insulin therapy during 10 to 14 days of hospitalization. Following this, half of the patients were randomized to continued insulin treatment and the other half to oral antidiabetes drugs (OAD), starting with metformin in overweight and obese patients and a sulfonylurea (SU), gliclazide, in lean patients. If satisfactory control was not obtained with a single OAD, a combination of metformin and the SU was used. Doses of insulin and the OAD were adjusted at each outpatient visit every 2 weeks during the first 2 months and every 4 weeks for another 4 months. Oral glucose tolerance tests were performed after the intensive insulin therapy: once just before randomization and again 6 months later. At that time, patients in the insulin group were switched to OAD and all patients were followed for another 6 months. As expected, FPG concentrations were no different at randomization: however, they were significantly increased in the OAD group compared with those maintained on insulin. A1C levels were significantly lower at 3 and 6 months in patients maintained on insulin compared with those given OAD. They also remained significantly lower 6 months after the insulin patients were switched to OAD. Glucose and insulin responses among the insulin and OAD groups to the …