Recent years have seen a shift in lifestyle and a rise in obesity rates, leading to a persistently high incidence of type 2 diabetes. On October 17, Sun Yat-sen University’s First Affiliated Hospital announced the results of a nationwide multicenter randomized controlled study. The research confirms that after intensive insulin therapy, sequential treatment with simplified oral hypoglycemic agents can sustain therapeutic benefits and optimize long-term blood glucose control. This approach has been termed the “Intensification-Simplification” strategy.
The findings were published in full on October 15 in the prestigious journal, the British Medical Journal (BMJ). The study’s corresponding author is Professor Li Yanbing from the hospital’s Department of Endocrinology, while the first authors include Associate Chief Physician Liu Liehua, Attending Physician Ke Weijian, and Deputy Chief Physician Li Hai from the same department.
Typically, diabetes treatment protocols follow a stepwise approach, where medications become increasingly complex to address escalating blood sugar levels and disease progression. However, this method often falls short in providing long-term efficacy, making it difficult to avoid chronic complications down the line.
Professor Li’s team has dedicated years to advancing diabetes reversal management. They discovered that utilizing short-term intensive insulin therapy can rapidly eliminate the toxic effects of high blood sugar, ultimately improving pancreatic beta-cell function and insulin sensitivity, which can induce a remission of diabetes. Nonetheless, without proper management, these benefits can diminish over time. Many patients also present with severe hyperglycemia at the time of diagnosis, complicating their long-term management.
To tackle these issues, the research team developed the “Intensification-Simplification” strategy. Following insulin therapy, participants were treated with simplified oral hypoglycemic agents to sustain the benefits and optimize long-term blood glucose control.
The study included 412 newly diagnosed type 2 diabetes patients, who first underwent two weeks of short-term intensive insulin treatment to normalize blood sugar levels and mitigate hyperglycemic toxicity. Participants were then randomly assigned to one of four treatment groups.
Results revealed that the combination of linagliptin and metformin had significant advantages, with the two single-agent sequential intervention groups also achieving favorable blood glucose outcomes. Additionally, the simplified oral medication regimen was well-tolerated, with less than 5% of participants stopping treatment due to adverse reactions.
This method allows for sufficient reversal of hyperglycemia through intensified management, followed by an easily manageable oral medication scheme for maintenance, facilitating long-term optimal blood sugar control. Moreover, this simplified management avoids the need for multiple medications or injectable treatments, leading to better patient compliance and lower healthcare costs.
The project received funding from the National Key Research and Development Program in 2018 and the Key Research and Development Program of Guangdong Province in 2019.
It is important to clarify that remission is not the same as cure. Professor Li stated that diabetes remission represents a manageable metabolic state, not a complete cure, and that the condition can recur due to lifestyle changes or weight gain. Achieving diabetes remission is a long-term struggle between patients and their lifestyle choices and health management.
