Recently, Professor Jianping Weng of the University of Science and Technology of China (USTC) and President of Anhui Medical University and his team of researchers from USTC, Southern Medical University and Peking University published the results of their latest research on the effects of early insulin therapy on cardiovascular health in adults with Type 2 Diabetes Mellitus (T2DM) in the journal Signal Transduction and Targeted Therapy. This study is the first in the world to demonstrate that early insulin therapy is associated with a significant reduction in the incidence of cardiovascular events in newly diagnosed patients with T2DM.

This research signifies a breakthrough in the field of diabetes treatment, compelling us to rethink the diabetes treatment model.

Diabetes has remained a serious global public health issue for over a century, with its burden only growing as populations shift to more urban, sedentary ways of living.  The heightened blood glucose levels of a person with diabetes can damage their cardiovascular systems, placing them at increased risk of cardiovascular events, which is why cardiovascular disease is one of the leading causes of mortality among people with diabetes. As such, effective blood glucose control, which has always been the main goal of diabetes therapy, is important to reduce the risk of cardiovascular events.

Professor Weng and his led observed a total of 5,424 patients with type 2 diabetes over a period of 24 years. The results showed that, compared with patients who did not receive early insulin therapy, those who did saw a 31% reduced incidence of stroke and 28% reduction in hospitalization for heart failure, though it found no significant difference in the risk of coronary heart disease. This discovery stands to change the way doctors and patients approach therapy options for new diagnoses of TD2M, as the significant cardiovascular benefits may lead more favoring early insulin adoption at a time when many first explore alternatives to insulin therapy.  

Over two decades of research by Professor Weng supports early insulin therapy

The traditional model for treating newly diagnosed T2DM is a conservative "step-by-step" method that typically begins with lifestyle changes such as diet and exercise, with physicians only recommending pharmaceutical intervention such as insulin once the disease has progressed and it is becoming clear that blood glucose levels are going uncontrolled. This can be a problematic approach, as this often means that patients go months, even years, with high blood glucose levels causing lasting internal damage and increasing risk of complications. After years of clinical experience struggling with this contradiction, in 2000 Chinese endocrinologists Jianping Weng and Linong Ji began formally exploring the effects of early insulin therapy on patient outcomes. Initial results proved promising, as early insulin therapy demonstrated an improvement in pancreatic islet secretion and reduced complications from diabetes. This study proved that, with the right therapy, T2DM could be reversed and thus became an important basis for the formulation of diabetes guidelines in many countries.

In 2001, Weng and Ji also coincidentally discovered that insulin intensification in type 2 diabetes can delay the progressive failure of beta cells. Subsequent observational studies by Weng's team showed that short-term intensive insulin treatment in patients with newly diagnosed T2DM and people with severe hyperglycemia could induce long-term improvements in blood glucose control and beta cell function. These research results were published in Diabetes Care in 2004.

Weng's team then conducted a multi-center randomized controlled study demonstrating that early insulin therapy was superior to oral blood glucose drugs in restoring and maintaining beta cell function and lowering overall blood glucose levels. These results were published in The Lancet in 2008, marking the first time such a 'honeymoon period' induced by early insulin therapy was mentioned in the prestigious publication. Weng and his team was the first to prove that pancreatic islet function in T2M is reversible, and successfully verified the "beta cell rest" theory in T2DM therapy.

Professor Weng said, "Clinical results show that early insulin therapy can not only successfully control blood glucose and reduce overall blood sugar levels, but also restore beta cell function and reduce insulin resistance. This new treatment method encourages us to rethink how we approach diabetes treatment and significantly impact how we formulate treatment strategies." Initially proposed to answer the question as to when physicians should recommend starting insulin treatment, Weng's research is still often cited by endocrinologists around the world, with Dutch journal Elsevier rating him as one of China's most cited scholars for three consecutive years from 2020 to 2022. The results of his studies on early insulin therapy have been cited by more than 60 treatment guidelines around the world, including "Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy" which was jointly published by American Diabetes Association and the European Diabetes Association in 2009 and the 2013, 2017, and 2020 editions of China's Type 2 Diabetes Prevention and Treatment Guidelines. The paper has also been included or cited in many endocrinology textbooks.

The cardiovascular benefits of early insulin therapy in people newly diagnosed with T2DM

For most people with T2DM, insulin therapy is eventually necessary in order to control blood glucose levels. Previous studies demonstrated that early insulin therapy can help control blood control and restore beta cell function in patients with type 2 diabetes, but how this therapy affected cardiovascular health has remained a mystery.

This recently published study into how early insulin therapy can reduce the incidence of cardiovascular events such as stroke, heart failure, and coronary heart disease in newly diagnosed patients with T2DM can be seen as a follow-up to Weng's 2008 article in The Lancet in that it demonstrates even further benefits from early insulin therapy on long-term patient outcomes. This new evidence promoting early insulin therapy could change the future of insulin therapy and provide key evidence for setting treatment guidelines.

Speaking on the results of this study, Professor Ji said, "Type 2 diabetes is an important risk factor for cardiovascular disease morbidity and mortality. Clinical guidelines also emphasize that, when selecting a potential therapy, in addition to lowering blood glucose levels, it is also very important to reduce the risk of cardiovascular events. Different patients should adopt individualized target management, blood sugar monitoring and corresponding treatment plans. We hope that this study will provide a basis for exploring more effective ways to reduce the risk of cardiovascular disease in patients with diabetes."

Early insulin therapy may bring cardiovascular benefits by improving blood glucose control in patients with type 2 diabetes, producing metabolic memory, reducing glucotoxicity, promoting the dedifferentiation of beta cells, improving beta cell function, and reducing the production of pro-inflammatory cytokines.

As research continues and treatment methods improve, studies such as this challenge us to rethink current diabetes treatment models and correct misconceptions about the use of insulin. With better treatment, newly diagnosed people with diabetes will be able to reduce complications and the long-term impact of their condition, helping them live longer and healthier lives.