This original research from Jothydev’s Diabetes Research Centre was presented at the 79th Scientific Sessions of American Diabetes Association at San Francisco from 7-11 June 2019. The study team headed by Dr.Jothydev Kesavadev included Dr.Rohit Warrier, Dr.Lakshmy Ramachandran, Dr.Arun Shankar, Dr.Ashwin David, Neethu A. Ajai, Geethu Sanal, Kavitha Thampiraj, Gopika Krishnan and Sunitha Jothydev. The study demonstrated the long term benefits of early insulin initiation (EII) in type 2 diabetes patients who were followed up for a period of 15 years.

In this observational cohort study, a comparison of early insulin initiators (≤7 years of T2DM onset) vs. late insulin initiators (≥8 years of onset) was done, in terms of CKD progression (eGFR decline), if any. Here, a total of 200 subjects in each arm were matched at baseline for BP, BMI, HbA1c and presence of other co-morbid illness that may confound results; both arms were closely followed up for 15 years through our Diabetes Tele Management System (DTMS®) based health care model. A paired t test was done for analyzing the eGFR decline within each arm.

It was observed that with the early insulin initiation group, a significantly lower dose of insulin is required (average of 9 units/day) to maintain glycemic control throughout than those with late initiation (average of 30 units/day). Factors including aggressive use of beta cell depleting drugs like sulfonylureas during early course of disease could be attributed to this; subsequently, during later stages, at initiation, a higher dose of insulin is needed to maintain glycemic control. It was observed towards the last visit at our center, among those in the late initiation arm, the decline in eGFR was significant (p<0.05), whereas in the early arm, eGFR was maintained throughout. The adjusted means for eGFR (Chronic Kidney Disease Epidemiology Collaboration formula) were plotted for both the groups over the follow up duration.

Early initiation of insulin potentially provides additional benefits in preventing eGFR decline and reducing total daily insulin requirement probably by preserving the beta cell mass.

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