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J. Clin. Med. 2018, 7(9), 235; https://doi.org/10.3390/jcm7090235

Short Course of Insulin Treatment versus Metformin in Newly Diagnosed Patients with Type 2 Diabetes

1
Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
2
CNR Institute of Neuroscience, 35127 Padua, Italy
3
ASST Lariana, Diabetes Unit, Ospedale Mariano Comense, 22066 Mariano Comense, Italy
4
Diabetes & Endocrine Unit, ASL Torino 5, 10123 Chieri, Italy
5
CNR Institute of Clinical Physiology, 56126 Pisa, Italy
These authors contributed equally to this work.
*
Author to whom correspondence should be addressed.
Received: 10 August 2018 / Revised: 20 August 2018 / Accepted: 21 August 2018 / Published: 23 August 2018
(This article belongs to the Special Issue Type 2 Diabetes: Update on Pathophysiology and Treatment)
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Abstract

The ß-cell dysfunction of type 2 diabetes is partly reversible. The optimal time window to induce glycemic remission is uncertain; short courses of insulin treatment have been tested as a strategy to induce remission. In a pilot study in 38 newly-diagnosed patients, we assessed the time-course of insulin sensitivity and ß-cell function (by repeat oral glucose tolerance tests) following a 6-week basal insulin treatment compared to metformin monotherapy in equipoised glycemic control. At 6 weeks, insulin secretion and sensitivity were increased in both groups whilst ß-cell glucose sensitivity was unchanged. From this time onwards, in the insulin group glycemia started to rise at 3 months, and was no longer different from baseline at 1 year. The initial improvement in insulin secretion and sensitivity dissipated. In the metformin group, fasting plasma glucose and HbA1c levels reached a nadir at 8 months, at which time insulin secretion, glucose and insulin sensitivity were significantly better than at baseline and higher than in the insulin group. A short course of basal insulin in newly-diagnosed patients does not appear to offer clinical advantage over recommended initiation with metformin. View Full-Text
Keywords: type 2 diabetes; diabetes remission; insulin treatment; newly-diagnosed diabetes; metformin type 2 diabetes; diabetes remission; insulin treatment; newly-diagnosed diabetes; metformin
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Seghieri, M.; Rebelos, E.; Mari, A.; Sciangula, L.; Giorda, C.; Ferrannini, E. Short Course of Insulin Treatment versus Metformin in Newly Diagnosed Patients with Type 2 Diabetes. J. Clin. Med. 2018, 7, 235.

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