(May 23, 2008 - Insidermedicine) Initiating intensive insulin therapy early in the course of type 2 diabetes can allow the beta-cells to recover and delay the progression of the disease better than oral antidiabetic therapy, according to research in The Lancet.

Here are some recommendations regarding the use of insulin in type 2 diabetes from the American Association of Clinical Endocrinologists:

•    Consider insulin therapy in patients with hemoglobin A1c levels greater than 8% and symptomatic hyperglycemia and in patients with elevated fasting blood glucose levels or exaggerated postprandial glucose excursions regardless of HbA1c levels.

•    Initiate insulin therapy to control hyperglycemia and to reverse glucose toxicity when the HbA1c level is greater than 10%.

•    Consider use of continuous subcutaneous insulin infusion in insulin-treated patients.

Researchers from Sun Yat-Sen University in Guangzhou randomized nearly 400 adults with type 2 diabetes to treatment with continuous subcutaneous insulin infusion, multiple daily insulin injections, or standard oral antidiabetic therapy. Treatment was stopped after regular blood glucose control was maintained for two weeks, after which diet and exercise were employed.

Patients in both insulin groups achieved normoglycemia sooner than those receiving oral antidiabetic therapy. Normal blood glucose levels were maintained for at least one year by 51% of those who received insulin infusions and 45% of those who received insulin injections, compared with only 27% on oral drugs. Beta-cell functioning also improved significantly in those treated with insulin.

Today's research demonstrates how short-term, intensive insulin therapy can stimulate beta-cell recovery in patients with type 2 diabetes, delaying the natural course of the disease.

For Insidermedicine in Depth, I'm Dr. Susan Sharma.