Conclusions

Current evidence indicates that SIIT can produce rapid glycemic improvement and partial recovery of β-cell function and insulin sensitivity in selected patients with newly diagnosed T2DM, particularly those with marked hyperglycemia and potentially reversible glucotoxicity. However, medication-supported glycemic control should not be equated with drug-free remission, and early benefits are frequently attenuated after treatment withdrawal. Severe hypoglycemia was not reported in trials providing detailed safety data, while transient weight gain was not consistently demonstrated. Sustained benefit appears to depend on continued management of insulin resistance, adiposity, hepatic metabolic dysfunction, and progressive β-cell decline, yet the optimal post-SIIT treatment strategy remains undefined. Because the evidence comprises only four heterogeneous randomized trials with inconsistent remission definitions, limited predictor analyses, and follow-up of no more than two years, SIIT should be considered a promising induction strategy rather than a routine remission therapy. Larger multicenter trials using standardized remission criteria are needed to identify appropriate candidates and determine the optimal type and duration of sequential maintenance treatment.