题名：Is There U Turn From Insulin Back to Pills in Diabetes?
作者：ERTEK S; CETINKALP S;
来源：Curr Vasc Pharmacol. 2013 Apr 25. [ IF= 0.00 ] ]
URL ：N U L L
摘要：Type 2 diabetes is characterized by insulin resistance together with progressive
loss of beta-cell function. After recognition of gluco- and lipo-toxicity,
attention was focused on the preservation and/or restoration of beta cell
function, especially at the early stages of the diabetes, with better beta-cell
reserve and in the absence of complications. Early treatment of glucotoxicity
with insulin was searched by early insulin treatment studies, and these studies
have some promising results, pointing the possibility of ''remission'' of
diabetes in some patients. According to the results of these studies, patients
with early diagnosis of diabetes, the ones with better beta cell reserve,
patients with low tendency for ''insulin-abuse'' could make ''U' -turn from
insulin to pills or even drug-free life. Criteria to turn back to pills could be
listed as disappearance of diabetic symptoms, daily insulin need < 0.25 unit/kg,
euglycemia in both fasting and postprandial state, and better beta cell function.
The main problems in early insulin treatment are the ''insulin resistance'' of
both patients and doctors, hypoglycemia, weight gain and increased appetite.
Meanwhile, hyperinsulinemia desensitizes receptors and causes worsening of
situation in a vicious cycle of insulin resistance and hyperglycemia. Therefore,
patients should be selected properly and U-turn could be performed in relevant
conditions explained in the text. It could be possible to see early insulin
treatment and U-turn strategies in future guidelines for type 2 diabetes.