Clinical Trials of Novel Strategies for Putting Type 2 Diabetes into Remission
Join Ravi Retnakaran, MD MSc FRCPC in the clinical trials of novel strategies for putting Type 2 Diabetes into remission . The natural history of type 2 diabetes (T2DM) is characterized by the progressive deterioration over time of insulin secretion by the pancreatic beta-cells (beta-cell dysfunction). Indeed, as current anti-diabetic medications have not yet been shown to profoundly alter this natural history of beta-cell decline, the typical clinical course of T2DM involves the sequential addition of anti-diabetic medications over time, followed ultimately by the institution of permanent insulin therapy (when beta-cell function declines to the point where glycemic control can no longer be achieved without exogenous insulin). Recently, it has emerged that, when instituted early in the course of T2DM, short-term treatment with intensive insulin therapy (IIT) for 2-3 weeks can temporarily improve beta-cell function and even induce a “glycemic remission”, in which patients are able to maintain normal glucose levels without any anti-diabetic medication. Importantly, although this remission can be sustained for over a year in some patients, it is ultimately temporary, owing to the ongoing deterioration of beta-cell function that still takes place after stopping the course of IIT. In this talk, we will discuss a series of innovative clinical trials involving novel strategies for applying this therapy to preserve beta-cell function in early T2DM, including two ongoing CIHR-funded randomized controlled trials that are currently recruiting (RESET IT and PREVAIL).