4. Discussion
T2D, STM, weight gain, diabetes, hypoglycemic, glucotoxicity, lipotoxicity
OBESE, INSULIN RESISTANCE, DYSFUNCTION, DIABETES
Results of our study support early 1-month insulin and metformin treatment’s superiority over glimepiride and metformin in newly diagnosed T2D, on beta cell (BC) functional recovery, glycemic and lipid control, enduring beyond the short span of treatment itself. The concept of early short-term insulin treatment in newly diagnosed T2D shifts away from the classic role of insulin at a later-stage of T2D. This early intervention may promote BC functional recovery, pointing to a disease-modifying effect of insulin treatment [Our results support previously reported advantages of early short-term insulin compared to oral-only treatment regarding glycemic and lipid control, extending beyond the brief span of treatment itself [Early short-term insulin treatment in newly diagnosed T2D may reverse gluco- and lipotoxicity, as main indirect contributors of BC dysfunction [C-Pep response augmentation parallel to glycemic control improvement, as observed in both of our treatment groups, highlights the universal importance of rapid elimination of glucotoxicity as instrumental in beta cell (BC) function recovery [Unlike comparable previous studies designed with either intensive insulin treatment with multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) [Due to limited duration and lower insulin dose requirements, the concept of early short-term insulin intervention leads to a smaller hypoglycemic risk and less weight gain than the classical late-stage, long-term insulin treatment, as is observed in our study. Furthermore, our preference for basal-insulin-only simplifies the insulin intervention in newly diagnosed T2D with high HbA1c. Our results should encourage practical implementation of early short-term insulin intervention in T2D.To the best of our knowledge, none of the diabetes treatment guidelines incorporate BC function assessment as input for therapeutic algorithms. However, heterogeneity is well-recognized among newly diagnosed T2D patients regarding causal predominance of insulin resistance or BC failure [We report of significantly greater C-Pep response to STM in females. Previous data from the mixed meal tolerance test indicated absence of sex-based difference in C-Pep response [The association of BMI and postprandial hormonal response is complex and most probably multidimensional. Higher baseline and postprandial insulin but with a delayed peak were observed in the obese [In prior studies, atherogenic index of plasma (AIP) was credited as a marker of BC dysfunction, inversely correlating with C-Pep secretion, and possibly predicting the need for insulin treatment [