Management of autoimmune diabetes for two years without insulin treatment: a case report

Abstract

We describe here a case of dietary and metformin intervention, achieving and maintaining normoglycaemia beyond two years from autoimmune diabetes diagnosis, without exogenous insulin. The case, a 53 year old white male, was initially diagnosed with typical type 2 diabetes, presenting with elevated fasting glucose and HbA_1c combined with excess weight (BMI 28). Metformin and dietary advice were very successful with good weight loss and subsequent HbA_1c near normal. However, eighteen months later, a routine HbA_1c test at 83 mmol/l (9.7%) suggested reversion to an autoimmune diabetes, confirmed by autoantibody test, and therefore considered type 1 diabetic and referred to a specialist clinic to begin insulin therapy. In the period between taking the sample and receiving the antibody results, the patient had begun home blood glucose monitoring and revising his carbohydrate intake downwards to achieve serum glucose targets. On the basis of this management, the patient refused insulin therapy and has maintained normoglycaemia for a period in excess of two years. The dietary regimen is reported as easy to manage, satisfying and represents less of a lifestyle impact and cost than would be the case for good glycemic control with insulin therapy. It seems likely that this approach could prove beneficial for many other newly diagnosed adult diabetics.