Innovative trial aims to induce remission of type 2 diabetes
Remission is well-known as the goal in cancer treatment but scientists are discovering it's also an exciting possibility for those with type 2 diabetes.
This new concept is being tested by researchers at Lawson Health Research Institute, who are challenging traditional type 2 diabetes treatment and testing an aggressive approach in recently diagnosed patients.
St. Joseph's Hospital in London is one of seven Canadian sites taking part in the innovative trial considered a significant and innovative departure in strategy in the care of people with type 2 diabetes. Known as the REMIT Study, it is being led by the Population Health Research Institute (PHRI), a joint institute of McMaster University and Hamilton Health Sciences. This trial follows a PHRI pilot study of early aggressive treatment that resulted in up to 40 per cent of 83 patients with type 2 diabetes going into remission and not needing any diabetes treatment for at least three months.
"For type 2 diabetes we have a wide array of new drugs, a wide array of new insulins, lots of choices, and we are doing our best with our family doctor colleagues, but we're not winning," explains Lawson researcher and endocrinologist Dr. Irene Hramiak, Chief of the Centre for Diabetes, Endocrinology and Metabolism at St. Joseph's. "We still have 50 per cent of patients with type 2 diabetes who are not reaching their blood sugar targets. Unfortunately our patients still are suffering the complications - amputations, eye disease, dialysis and heart attacks from their diabetes. So we have to stop and ask maybe it's our approach."
The standard treatment for people diagnosed with type 2 diabetes is to start on a single medication, which is then followed by the addition of more drugs and insulin as the disease progresses.
"We don't start multiple drugs all at once," says Dr. Hramiak. "We take one at time. We wait until you run out of efficacy from that drug, which can take a variable length of time and then we add a drug. But over the course of many years, there are lag periods and people spend a lot of time poorly controlled rather than well controlled because of the progressive nature of the disease."
The experimental treatment will see patients receiving intensive treatment - two drugs plus insulin at bedtime - for three months to see if remission can be induced.
"It's a proactive approach," says Dr. Hramiak. "The theory is that we should be aggressive with treatment early in the disease and that may slow the progression of the disease."
A total of 152 patients are being sought in Canada - 25 at St Joseph's Health Care London - who have been diagnosed with type 2 diabetes within the last eight years. Those who would like more information about the trial can call 519 646-6100 ext. 65423.
"It's quite innovative," says Dr. Hramiak of the experimental treatment. "It's really changing the disease and inducing remission rather than treating disease. It's a huge difference to our overall approach."