A few years ago, a patient told me how he was first diagnosed with type 2 diabetes during a routine physical. He asked his doctor “Is there a cure for diabetes?” His doctor replied, “No, there is not.” My patient then asked, “Will I die from it?” The doctor replied, “No, you will not die from it if you look after yourself.” Mark (not his real name) and his doctor then went on to discuss how to manage his diabetes and prevent its complications: attend diabetes education sessions, incorporate healthy lifestyle practices and start on diabetes medication. Mark’s outlook was very proactive and he decided he wanted to take control of his diabetes instead of letting it take control of him.
One way to be proactive is to enroll in a clinical trial, investigating better ways to treat and lessen the long-term severity of type 2 diabetes.
The REmission Studies Evaluating T2DM: Intermittent Insulin Therapy (RESET IT) trial is testing to see if beta-cells (which produce insulin) can continue functioning over long periods of time. As diabetes progresses, our beta-cells make less insulin. The resulting beta-cell dysfunction leads to loss of blood glucose control, despite medication. This eventually means insulin therapy.
One of the factors contributing to beta-cell dysfunction is glucotoxicity (elevated glucose levels). So the theory is that in the early stages of type 2 diabetes, eliminating glucotoxicity would reverse some of the beta-cell dysfunction that leads to the worsening of diabetes. In short, the sooner you control your glucose, the better.
There have been many studies supporting the short-term use of intensive insulin therapy early in the course of type 2 diabetes to improve beta-cell function. After shortterm insulin therapy for two to five weeks, the rates of drug-free remission of diabetes are about 66 percent at three months, 59 percent at six months, and 46 percent at 12 months. However, this remission wanes over time. Thus, the next step is clinical trials focusing on trying to maintain this initial beneficial effect of insulin therapy.
The RESET IT Trial is funded by the Canadian Institutes of Health Research and is currently recruiting patients in Toronto, Hamilton and London. Principal investigators are Dr. R. Retnakaran and Dr. B. Zinman. The main eligibility recruitment criteria are:
- Type 2 diabetes diagnosed within the last five years
- On either metforin (or glumetza) or treating diabetes with lifestyle only.
For more information, please contact Ms. Haysook Choi, nurse research coordinator, certified diabetes educator Mt. Sinai Hospital at (416) 586-8778 or firstname.lastname@example.org.