Downward insulin therapy in type 2 diabetes

Abstract

Aim: Despite increasing insulin doses, glycemic regulation fails in many obese patients with type 2 diabetes, The purpose of the present study was to compare the effects of increasing and decreasing insulin doses adjustments in obese type 2 diabetic patients with poor glycemic control. Methods: Sixty type 2 diabetic patients with poor glycemic control under insulin treatment and had gained at least five kilograms in the last year were randomized into either conventional (increasing insulin doses) and downward insulin dosage groups. All patients had been given education on healthy eating and exercise in all visits. Patients’ obesity parameters (as waist circumference and weight) and glycemic controls evaluated at the end of sixth months, respectively) in downward dose adjustment group and increased (from 110.7 to 115.6 cm and 83.2 to 84.6 kg, respectively) in conventional insulin dose adjustments. Both groups had significant reduction in HbA1C levels (from 9.64 to 9.12, and from 10.05 to 8.86; p=0.024, p=0.003; respectively). Changes in HbA1C levels were similar in the groups (p=0.12). Conclusion: Downward insulin dose adjustment with intensified life style modifications provided weight loss and reduction in waist circumference similar to the levels achieved with glycemic control with conventional insulin dose adjustments.