"Shock and Awe" Comes to Type 2

For years treating type 2 has followed a predictable path:

1. First, try to modify symptoms through diet and exercise
2. As the disease progresses, add metformin to the mix
3. When metformin becomes less effective, introduce a sulfonylurea on top of the metformin
4. When oral medications no longer work, start the patient on once-a-day insulin
5. When that’s no longer effective, start the patient on multiple daily insulin shots—long-lasting basal insulin to give basic day-long control, and short-term bolus insulin shots to handle spikes from meals

All of this is predicated on the central fact of type 2 life: Our pancreatic beta cells, which produce the insulin that we have become resistant to, are under constant assault by our high blood sugars. They struggle to make insulin under increasingly heavy assault and distress. Think of a factory worker who has been placed on a permanent double shift and is rewarded with a cut in pay and no vacations. It doesn’t take much to imagine how long that worker will hold up under such conditions.

However, researchers at the University of Texas Southwestern Medical Center may have found a way to keep the beta cells on newly diagnosed, drug-naïve type 2s functional for several years before damage from diabetes sets in, according to this recent study. 

It’s a pretty straightforward treatment plan: Overwhelm the diabetes from the get-go with a combination of insulin and metformin, or a three-drug oral therapy that consists of glyburide, metformin, and pioglitazone.

According to the study, either course of treatment extended beta cell function by an average of 3.5 years. Both methods were tested on 58 newly diagnosed patients over several years.

This is an almost complete departure from traditional treatment for type 2 diabetes. Rather than sitting on the porch sipping lemonade and sedately waiting for diabetes to eventually have its way, the Texas researchers say storm the disease with every good weapon in the medical arsenal.

(I’m a bit of a history buff, and the Texas approach is very much like classic U.S. military doctrine: Hit a foe on his turf with overwhelming force. Make it quick and make it decisive.)

It's likely that this approach (which will have to be replicated by other researchers) will only be effective with new type 2 patients. But this is where our membership in the community of people with type 2 comes into play. When we meet somebody who is newly diagnosed, it would be a favor to them to tell them about the University of Texas research — it’s news they can pass on to their doctors and endocrinologists, which may lead to a more aggressive approach in managing their type 2, and one that will help them continue producing insulin at a higher volume for a few more years.