Novel Strategies for Inducing Glycemic Remission during the Honeymoon Phase of Type 2 Diabetes.

A lofty goal in the management of type 2 diabetes is the achievement of glycemic remission. Glycemic remission can be defined as the sustained maintenance of normoglycemia without antidiabetic therapy for variable periods of time after stopping an initial disease-modifying intervention. Although this goal remains largely elusive at this time, growing recognition of the potential reversibility of pancreatic beta-cell dysfunction early in the course of type 2 diabetes has yielded a target for such disease modification. Furthermore, short-term intensive insulin therapy for 2 to 5 weeks has emerged as an intervention that could be applied as a biologic agent for this purpose during a window of opportunity that we have called the honeymoon phase of type 2 diabetes. This recognition has led to a novel therapeutic paradigm consisting of initial induction therapy to improve reversible beta-cell dysfunction during the honeymoon phase, followed by maintenance therapy aimed at preserving this beneficial beta-cell effect. This concept of induction and maintenance therapy is being applied in a series of recent and ongoing clinical trials, toward the goal of ultimately preserving beta-cell function and thereby modifying the natural history of type 2 diabetes.