Effects of early introduction of intensive insulin therapy on the clinical course in non-obese NIDDM patients.

In order to reconsider the extent of indication of insulin therapy in non-insulin dependent diabetes mellitus (NIDDM), we performed the following trial in a prospective fashion. At the beginning phase of treatment for diabetes, we introduced intensive insulin therapy in 22 non-obese (Body mass index approximately 24 kg/m2) NIDDM patients without proliferative retinopathy, who were selected in a standardized fashion, avoiding any arbitrary choice. None had received oral hypoglycemic agents (OHA) or insulin yet. By administering insulin 3 or 4 times a day, strict glycemic control was attained and maintained, and then the insulin dose was gradually lowered while keeping good glycemic control. In patients whose glycemic control was maintained at an excellent level for more than 7 days under an insulin dosage lower than 8 u/day, insulin therapy was discontinued. As a result, 15 patients (68%) attained good glycemic control both without insulin and OHA almost within a month and 6 patients (27%) shifted to OHA. It is recommended to introduce intensive insulin therapy in non-obese NIDDM patients without proliferative retinopathy and to aim at attaining good glycemic control both without insulin and OHA.