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Post by mnholdem on Oct 20, 2015 11:04:53 GMT -5
This is, in my opinion, an excellent article of experts discussing the merits of early intensive insulin treatment.
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Short-term intensive insulin therapy at diagnosis in type 2 diabetes: plan for filling the gaps Article first published online: 18 NOV 2014
DOI: 10.1002/dmrr.2603
© 2014 The Authors. Diabetes Metabolism Research and Reviews published by John Wiley & Sons, Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Summary
"Short-term intensive insulin therapy is unique amongst therapies for type 2 diabetes because it offers the potential to preserve and improve beta-cell function without additional pharmacological treatment. On the basis of clinical experience and the promising results of a series of studies in newly diagnosed patients, mostly in Asian populations, an expert workshop was convened to assess the available evidence and the potential application of short-term intensive insulin therapy should it be advocated for inclusion in clinical practice. Participants included primary care physicians and endocrinologists. We endorse the concept of short-term intensive insulin therapy as an option for some patients with type 2 diabetes at the time of diagnosis and have identified the following six areas where additional knowledge could help clarify optimal use in clinical practice: (1) generalizability to primary care, (2) target population and biomarkers, (3) follow-up treatment, (4) education of patients and providers, (5) relevance of ethnicity, and (6) health economics. © 2014 The Authors. Diabetes Metabolism Research and Reviews published by John Wiley & Sons, Ltd."
onlinelibrary.wiley.com/doi/10.1002/dmrr.2603/full
NOTE: Be sure you are on the Article tab
TIP: Reference numbers (i.e. [34] ) appear throughout the article. These reference can lead you to some incredibly important and useful information.
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Post by liane on Oct 20, 2015 11:15:23 GMT -5
This is the paradigm shift we need to be widely accepted. Good find!
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Post by mnholdem on Oct 20, 2015 14:09:35 GMT -5
Additional remarks these PCPs and Endocrinologists published in this report about Short-Term Intensive Insulin [STII] therapy:
"Building on results of this trial and those of six other smaller trials of STII therapy, a meta-analysis involving 839 participants (including 251 patients randomized to STII therapy in the above study [44]) was performed and further underscored the robustness of the evidence supporting STII therapy [50]. In that analysis, 46% of patients remained in drug-free remission after 12 months. All but one study showed an improvement in beta-cell function, as assessed by homeostatic model assessment [HOMA]-B, and all but one study showed a decrease in insulin resistance, as assessed by HOMA-IR.
"In the pooled data, the proportion of patients in drug-free remission was
66.2% [292/441] at 3 months, 58.9% [222/377] at 6 months, 46.3% [229/495] at 12 months, and 42.1% [53/126] at 24 months.
"These rates of remission are far greater than those that can be achieved with any other currently available medical therapy for diabetes.
"Despite these promising results, the use of insulin as a first-line therapy in newly diagnosed patients with type 2 diabetes remains underutilized as an effective treatment option."
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Unbelievable. Because of the needle-resistance that is exhibited in many (if not most) early T2's, Afrezza would be tailor-made for this type of study and, eventually, this therapy. This is the STII therapy that Al Mann has discussed in interviews and has been advocating for many, many years.
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Post by mnholdem on Oct 21, 2015 21:48:01 GMT -5
This is the paradigm shift we need to be widely accepted. Good find!
That was the opinion of this panel of experts, as well:
Conclusions
"STII therapy offers the potential of preserving beta-cell function and inducing a clinically significant, drug-free period of remission in newly diagnosed patients with type 2 diabetes, and it would be helpful to have this recognized in expert treatment guidelines. We recognize that this represents a major paradigm shift in how the medical community typically thinks about diabetes and insulin. The idea of using insulin as a way to alter the natural course of disease is novel to patients and health care providers alike."
I may email this article to Sanofi's Pascale Witz, along with a recommendation that Sanofi fund a study that uses Afrezza for Short-Term Intensive Insulin therapy. Perhaps it could be done with this Asian group of diabetes experts, since Afrezza is going to Japan anyway. I would think they'd be eager. I've also read that Japan/China has a very needle-phobic population. With Afrezza, patients would be able to self-administer with the inhaler instead of daily trips to the endo/PCP at a medical centers or clinics for titration and insulin injections.
As I understand it, STII therapy only lasts 2-4 weeks, so it wouldn't take very long to gather clinical evidence that could shake up the diabetes community.
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Post by mnholdem on Apr 10, 2016 15:45:29 GMT -5
I ran across this interesting briefing on the topic of Intensive Insulin Treatment, so I thought I'd update this older thread. RESEARCH REPORT NEWS PODCAST: INTENSIVE DIABETES THERAPY SHOWN TO REDUCE HEART DISEASE RISK
A recent study found that when participant’s complete intensive therapy for managing their type 1 diabetes, they experienced significant cardiovascular benefits over the next 30 years.
Researchers used information from about 1,440 diabetes patients who were participating in the Diabetes Control and Complications Trial. The goal was to determine whether intensive therapy during the trial had an effect on the rate of heart disease over 30 years of follow-up.
The findings showed a 30% reduction in heart disease over a 30-year follow-up period. There was also a 32% decrease in the incidence of major cardiovascular disease events among type 1 diabetes patients in intensive therapy.
These findings were published in Diabetes Care on February 9, 2016.Source: www.diabeteshealthpharmacist.com/research-report-podcast-intensive-diabetes-therapy-shown-to-reduce-heart-disease-risk/ |
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