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While aggressive early intervention may be useful for diabetes patients, that intervention must be sustained.
Around 84 million Americans-about 1 in 3 people in the country-have what’s known as prediabetes, according to the CDC. Prediabetes can then lead to type 2 diabetes. But a study from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health, finds that early intervention in patients with prediabetes or newly-diagnosed patients with type 2 diabetes can help to increase insulin production.
The study examined the role of three different treatments and the possibility of slowing the decline of beta cell function, an effect of diabetes. Patients were given either long-acting insulin (glargine) for three months followed by nine months of metformin, liraglutide with metformin for 12 months, metformin alone for 12 months, or a placebo.
All three of the interventions resulted in higher beta cell function. The largest improvement was seen in the group receiving both liraglutide and metformin. However, after examining the patients three months after treatments ended, there was no evidence that the effects were sustained.
“The findings suggest that in individuals with either of these states of dysregulated glucose metabolism, intervening very early can improve insulin production,” study author Steven Kahn, MD, tells Managed Healthcare Executive. “However, as this is not sustained after treatment withdrawal, it indicates that at this time we do not have a treatment approach that can be used intermittently but rather that we have to continue therapy without periods of withdrawal.”
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The study also showed that younger patients do not respond as well to treatment-even sustained treatment-as older patients.
When patients aged 10 to 19 were given similar interventions as the adult group (ages 20 to 65), beta cell function declined during treatment and then worsened after treatment ended. The younger patients were given only two treatment regimens: three months of insulin glargine followed by metformin for nine months as well as metformin alone for 12 months, because metformin and insulin glargine are the only diabetes 2 treatments approved for youth with type 2 diabetes.
“The findings in both age groups therefore suggest that we should focus on better understanding the disease process in youth as to why it is more aggressive,” says Kahn, “and should be trying to identify new targets that can improve and maintain beta-cell function in both youth and adults.”
Nicholas Hamm is an editor with Managed Healthcare Executive