This original abstract was presented at the American Diabetes Association's 73rd Scientific Sessions in June 2013 from Jothydev’s Diabetes Research Centre.

Initial therapy of newly diagnosed T2D is often based on clinical judgement & varies from physician to physician. Short term intensive insulin should lay a strong foundation addressing glucotoxicity & possible beneficial effect on declining beta cells. The long term impact of initial insulin therapy in new onset T2D was retrospectively evaluated.

We analyzed data of new onset T2D presenting from Feb 2005-Jan 2007 with reported diabetes duration of few days to 1 year. Subjects ineligible for intensive glycemic control & already on secretogogues were excluded. 452 compliant T2D were de-identified & 5 year follow up electronic data in Diabetes Tele Management System (DTMS®) was analysed:age 28-49 years; average HbA1c 9.7% (1.6) at baseline & either drug naïve or on metformin monotherapy. DTMS® involves a unique software & trained multidisciplinary diabetes team communicating with patients through phone/email for slow, steady titration of drugs combined with frequent tele counselling. Patients were initiated on insulin along with other medications. 76% & 24% were on basal & biphasic insulin respectively.At 6-8 months, insulin was gradually down-titrated. 4% required continuation of insulin (A1c 7.2%) & 4% were controlled with lifestyle modification alone (A1c 5.4%), 72% were continued on metformin monotherapy (A1c 6.6%) while 20% on metformin-gliptin (A1c 6.0%). Average HbA1c at 5 years was 6.3%(1.7).Hypoglycemia(0.8%)& unacceptable weight gain were prevented with advice via DTMS.

In newly diagnosed T2D, judicious selection of motivated patients for initial insulin treatment of 6-8 months not only lowers HbA1c but also makes treatment less cumbersome & cost effective in the long run. At 5 years patients required minimal dosages of oral drugs, had better glycemic control with minimal glycemic excursions. Initial therapy with injections, periodic education, intensive lifestyle modifications with excellent outcomes is a strong motivating force for sustained glycemic control in years to come.