Short-Term Intensive Insulin Therapy as a Remission Induction Strategy in Newly Diagnosed Type 2 Diabetes Mellitus: A Systematic Review
Abstract
Type 2 diabetes mellitus (T2DM) is characterized by progressive β-cell dysfunction, insulin resistance, and glucotoxicity, some of which may remain reversible early in the disease course. Short-term intensive insulin therapy (SIIT) may rapidly normalize hyperglycemia and facilitate β-cell recovery in newly diagnosed T2DM. This systematic review evaluated the effects of SIIT on glycemic control, drug-free remission, β-cell function, durability, and safety. PubMed/MEDLINE, Scopus, and Web of Science were searched for English-language randomized controlled trials published during the five-year period ending in April 2026. Four trials met the eligibility criteria. Because interventions, remission definitions, maintenance strategies, and follow-up periods differed substantially, study-level effect estimates, 95% confidence intervals, and p values were synthesized without statistical pooling. SIIT consistently improved early glycemic control, β-cell function, and insulin sensitivity. In one 245-participant trial, medication-supported hemoglobin A1c (HbA1c) below 6.5% at three months was achieved by 78.7% of participants receiving SIIT plus metformin-pioglitazone versus 59.0% receiving SIIT alone (adjusted p < 0.05); however, 12-month drug-free remission rates were similar at 50.0% and 50.6%, respectively (p = 0.972). Another trial found that linagliptin-metformin maintenance after SIIT increased the adjusted odds of achieving HbA1c below 7.0% at 48 weeks (odds ratio 2.78, 95%…
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