Best Way to Fight Type 2 Diabetes: Not What You Think
The conventional way to fight type 2 diabetes is to focus on diet, exercise, weight loss and, as recommended by the American Diabetes Association, to take the standard antidiabetes drug--metformin. But the authors of a new study say they have the best way to fight type 2 diabetes, and it's not business as usual.
This diabetes treatment could be a breakthrough
If you want to make a significant impact on type 2 diabetes, then you need to treat it fast and aggressively, according to Dr. Ildiko Lingvay, assistant professor of internal medicine at University of Texas Southwestern Medical Center. Although diet, exercise, and weight management are certainly important, early and intensive treatment "can potentially change the course of this prevalent disease, which would represent a breakthrough," noted Lingvay.
The trial consisted of 58 patients, ages 21 to 70, who had been newly diagnosed with type 2 diabetes. All the participants were treated with insulin and metformin during a three-month lead-in period, after which they were randomly assigned to one of two groups for 3.5 years of treatment: continuation of insulin plus metformin, or a trio of drugs--metformin, glyburide, and pioglitazone.
The goal of the trial was to determine whether early, aggressive therapy using an insulin-based approach or a trio of oral antidiabetes drugs would help preserve or even improve beta-cell function over 42 months.
Beta cells manufacture and release insulin and amylin, hormones that regulate sugar (glucose) levels in the blood. The beta cells are in tune with the body's glucose levels and can quickly release extra insulin when it's needed. Individuals who have type 2 diabetes have dysfunctional beta cells that gradually stop functioning.
After 3.5 years, the investigators found the following:
- No significant change in beta-cell function in either treatment group
- Excellent glycemic control in both groups
- Amount of weight gained was similar between the groups
- The occurrence of hypoglycemic episodes decreased significantly over time and was similar between the groups
The authors concluded that an early and intensive treatment approach using either insulin plus metformin or the trio of diabetes drugs can preserve beta-cell function for at least 3.5 years.
Why do the UT Southwestern researchers believe their aggressive approach, which has been used at the university for at least 10 years, works and the conventional approach does not? Dr. Lingvay explained "We believe that the stepwise approach [the standard method] exposes patients to long periods of high blood sugar, which leads to complications."
Lingvay emphasized that type 2 diabetes is a progressive disease and that individuals need to make and maintain significant dietary changes if they hope to preserve some insulin production. However, dietary noncompliance among type 2 diabetics is common.
The UT Southwestern trial, which is a six-year study and therefore still ongoing, has so far demonstrated that an intensive treatment approach can preserve insulin production, and that individuals have responded to both drug therapy methods equally well. Participants have been followed closely, with clinic visits every 3 months, intensive monitoring of their medications, regular compliance checks, and lots of encouragement, all of which "likely improved patient satisfaction and compliance."
Type 2 diabetes is an epidemic and a condition caused mainly by lifestyle choices and some genetic components. The disease can be reversed in some people if they make a commitment to change their diet and exercise habits and stick with it.
Experts like Neal Barnard, MD, author of Dr. Neal Barnard's Program for Reversing Diabetes: The Scientifically Proven System for Reversing Diabetes without Drugs, have shown it is possible to fight the disease without medications. Numerous physicians and organizations have echoed this approach.
In a CNN report, Dr. Michelle Magee, director of the MedStar Diabetes Institute in Washington, noted that "We have seen numerous people reverse their condition." She noted, however, that "it takes a real dedication for the rest of their lives."
The aggressive drug treatment method promoted by UT Southwestern researchers also requires compliance if people hope to fight type 2 diabetes. Lingvay explained that "We have shown that this preserves beta-cell function, and that's the key in changing the course of the disease."
CNN: Reversing diabetes is possible, Jan. 28, 2011
Harrison LB et al. B-cell function preservation after 3.5 years of intensive diabetes therapy. Diabetes Care 2012 Jul; 35(7): 1406-12