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Improvements in beta-cell function lost on treatment withdrawal

By Colin Kenny, Editor – Diabetes Distilled

In this study, the effects of different pharmacological approaches to improving beta-cell function were compared in individuals with impaired glucose tolerance (IGT) and in treatment-naive individuals with diabetes duration of less than a year. Participants were randomised to receive 12 months of metformin alone, insulin glargine followed by metformin, 12 months of liraglutide plus metformin or 12 months of placebo. Researchers found that pharmaceutical interventions improved beta-cell function during active treatment but failed to produce persistent benefits after treatment withdrawal in people with IGT or recently-diagnosed type 2 diabetes. 

In the Restoring Insulin Secretion (RISE) Adult Medication Study, investigators wanted to see whether various targeted pharmacological approaches preserved or improved beta-cell function in individuals with IGT or with treatment-naive type 2 diabetes of less than a year’s duration. In total, 267 adults with IGT or recently-diagnosed type 2 diabetes were randomised to receive one of four management approaches:

  • 12 months of metformin alone;
  • 3 months of insulin glargine (target fasting glucose of <5 mmol/L) followed by 9 months of metformin;
  • 12 months of liraglutide plus metformin; or
  • 12 months of placebo. 

 
Compared to placebo, the three active treatments produced on-treatment improvements in HbA1c levels, glucose-stimulated C-peptide response and weight loss at 12 months. Participants receiving liraglutide plus metformin demonstrated the greatest improvements. 

The on-treatment improvements in beta-cell function were unfortunately not sustained; all of the effects of treatment had disappeared by 3 months after treatment withdrawal. The investigators concluded that continued intervention may be required to alter the progressive beta-cell dysfunction that occurs in individuals with IGT or early type 2 diabetes.
 
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