1. Positive Outcomes with Early Initiation of

Insulin Therapy in Type 2 Diabetes Mellitus

This original research was conducted at Jothydev’s Diabetes Research Centre and presented by Dr.Jothydev Kesavadev at the American Association of Clinical Endocrinologists (AACE) 26th Annual Scientific & Clinical Congress conducted at Austin, Texas, USA.

Objective: Several studies have proven the benefits of early and aggressive intervention in lowering blood glucose and thereby reducing the risk of long term complications. However, “clinical inertia” seen among physicians and “psychological insulin resistance” seen among patients has been recognized as predominant inhibiting factors towards timely initiation, or intensification of insulin therapy even when it is clinically indicated. By means of a retrospective analysis, we have tried to evaluate the benefits underlying early initiation of insulin therapy among type 2 diabetes mellitus (T2DM) patients attending our clinic.

Methods: Electronic medical records of patients enrolled at our clinic during Jan 2005 to Jan 2010 were scrutinised to identify patients who were detected with new onset T2DM (diabetes duration <1 year) and subsequently initiated on insulin. Their follow-up data were analysed retrospectively to investigate the benefits underlying early initiation of insulin therapy. Statistical analysis (Paired t test) was done using GraphPad Prism version 6.01 for Windows. Results: 57 patients were de-identified and had a mean age of 42.93±11.85 years; mean HbA1c of 10.90±2.15%; mean Fasting Blood Sugar (FBS) of 200.4±62.63mg/dL; mean Post Prandial Blood Sugar (PPBS) of 348.0±139.3mg/dL and mean Body Mass Index (BMI) of 26.42±4.07kg/m2 at baseline. Total Daily Dose of Insulin (TDD) was found to be 21.67±14.61U. Upon analysis of the most recent follow-up data of these patients (as on October 2016), different clinical parameters were found to improve significantly from their baseline levels. Mean HbA1c was found to be 7.56±1.91% (p<0.0001); mean FBS = 141.3±54.76mg/dL (p<0.0001); mean PPBS = 159.0±40.26mg/dL (p=0.0186) and mean BMI = 25.58±3.79kg/m2 (p=0.0003). TDD required was found to remain stable (13.45±10.30U; p=0.0664) without requiring further escalated doses even with the progression of disease duration.

Discussion: Results reveal the advantages of early initiation of insulin in T2DM individuals. It aided in improving the clinical parameters of the patients which in turn can delay the development of diabetes associated complications. The escalation required in TDD usually observed with progression of the disease could also be avoided with this early intervention of insulin therapy.

Conclusion: Early insulin initiation in eligible candidates improves their clinical profile thereby delaying the onset of diabetes associated complications. This delay in onset of complications along with minimal insulin dosages required can also significantly bring down the cost of diabetes treatment.

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