Saturday, May 24, 2008

Type 2 Diabetes in Remission?

Reading through some diabetes news updates this morning, I ran across a few articles talking about a new study. Some newly diagnosed diabetics in China had been given insulin, and a year later they were still 'in remission'. I've never heard that term applied to diabetes, and I was a bit confused. How much insulin were they taking? How often? And what did they mean by 'Remission'? Diabetes doesn't just go away for a while, as far as I know.

The entire article isn't available online - unless I shell out $30 bucks - but I gleaned what I could from the abstract on The Lancet's Website. Here's what they did:

They found 382 newly diagnosed diabetics who were not yet on medication. They had fasting levels between 7.0-16.7 mmol/L (126-301). They split them into three groups and gave one group oral meds (they don't specify which in the abstract), another group multiple daily injections, and a third "continuous subcutaneous insulin infusion" which I assume means some kind of pump.

They tracked how long it took patient to achieve "normoglycemia" - non diabetic responses to some tests, possibly the glucose tolerance tests, insulin, and proinsulin levels. Not surprisingly, insulin - especially the continuous infusion - brought glucose levels back to normal the fastest.

Once someone had maintained this for two weeks, they took them off the treatment they were on. All patients were switch to a diet-and-exercise management routine. There are no details on what diet they were on, but I would assume it as similar for all patients.

A year later, they went back and retested the patients. If a patient still showed normal responses on their tests, they said they were 'in remission'. 50% of those on the insulin treatments were 'in remission' as well as 27% of those on oral meds.

The tests they run showed that the beta cell function was "improved significantly after intensive interventions". However, the improvement declined in the patients who were treated with oral meds.

The bottom line here seems to be that for half of the patients, receiving insulin treatments restored some of their beta cell function for at least a year. That's pretty amazing to me, and it opens a lot of questions. Why did it work for some but not others? Was their any affect on their A1C? This is definitely a finding that needs more research.

I've linked the abstract above, but there's an article by someone who's read the whole article and not just the abstract available at Medical News Today.

3 comments:

Anonymous said...

Hi Laura. The abstract says that "Early intensive insulin therapy in patients with newly diagnosed type 2 diabetes has favourable outcomes on recovery and maintenance of β-cell function and protracted glycaemic remission compared with treatment with oral hypoglycaemic agents."

It would be interesting to know how closely the diabetic groups in the study followed their diet/exercise regimens.

Also, what about those T2s who make plenty of their own insulin, but simply aren't able to use it? Their beta cell function (insulin production) might have been fine throughout the program, even though their blood sugars were initially out of whack. Often, changes in exercise and diet alone can have a positive, lasting effect on the ability to use insulin and control blood sugar. I wonder how these considerations were accounted for in the study.

Thanks for posting the links, and if you're able to find the full report, please let us know.

Laura Williams said...

It sure opens a lot of questions, doesn't it. That 50 percent could be doing something different that wasn't tracked, could be on a regional diet, or could have been the ones with low insulin production. I don't know. It doesn't seem to make sense to me that a few weeks on insulin would have that big of an affect, but perhaps giving the beta cells a 'rest' can put back the progress of the disease somehow.

Unknown said...

i would say this i am a type 2 diabetic and i have just hit remission status it is possible for a type 2 to do so i dont know about type 1 it took me 6 years to get here though , diet exercise and just not eating anything with 2 grams or more per serving of sugar in them and i am finally normal on sugars 95 in the morning and i dont get higher than 130 two hours after a meal so it can be done but its a fight dont let your diesease run you run your diesaes