Approximately 40% of people with type 2 diabetes eventually require some type of insulin treatment to control their blood glucose, either because their diabetes gets worse or it no longer responds to oral drugs. But now a study in The Lancet suggests that starting insulin early may do more than just control diabetes – it may induce remission in type 2 diabetes.

People with type 2 diabetes typically do not take insulin until they can no longer control blood glucose levels with lifestyle changes and oral medications. However, several studies have shown that early use of insulin by those newly diagnosed with type 2 diabetes may induce a "remission" of the disease that can last for a year or more.

A study reported in The Lancet (volume 371, page 1753) suggests why. Researchers randomized 382 newly diagnosed people with type 2 diabetes into three groups: One received multiple daily insulin injections, the second used insulin pumps (which provide a continuous infusion), and a third was given intensive treatment with oral medications. The aim was to achieve rapid glycemic control in all groups.

A year later, just 27% of participants taking oral medications were in remission, compared with 45% injecting insulin and 51% who used insulin pumps. Remission was defined as the ability to maintain normal glucose levels with diet alone. More participants taking insulin achieved blood glucose control than those on oral medications and in less time, too.

Insulin may confer benefits in addition to glucose lowering that promote remission, such as reducing inflammation and improving the function of beta cells that produce insulin. Importantly, treating type 2 diabetes early with aggressive insulin therapy may slow and even prevent the onset of complications.