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© 2004 by the American Diabetes Association, Inc.
Clinical Care/Education/Nutrition |
Induction of Long-term Glycemic Control in Newly Diagnosed Type 2 Diabetic Patients Is Associated With Improvement of ß-Cell Function
From the Department of Endocrinology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
Address correspondence and reprint requests to Professor JianPing Weng, Department of Endocrinology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China 510080. E-mail: gzwengjp{at}pub.guangzhou.gd.cn
OBJECTIVE—To investigate whether long-term optimal glycemic control can be achieved without medication by transient continuous subcutaneous insulin infusion (CSII) and the possible mechanisms responsible for this remission.
RESEARCH DESIGN AND METHODS—Newly diagnosed type 2 diabetic patients (n = 138, fasting glucose >11.1mmol/l) were hospitalized and treated with CSII for 2 weeks. Intravenous glucose tolerance tests (IVGTTs) were performed, and blood glucose, HbA1c, lipid profiles, proinsulin, insulin, and C-peptide were measured before and after CSII. Patients were followed longitudinally on diet alone after withdrawal of insulin.
RESULTS—Optimal glycemic control was achieved within 6.3 ± 3.9 days by CSII in 126 patients. The remission rates (percentages maintaining near euglycemia) at the third, sixth, twelfth, and twenty-fourth month were 72.6, 67.0, 47.1, and 42.3%, respectively. Patients who maintained glycemic control >12 months (remission group) had greater recovery of ß-cell function than those who did not (nonremission group) when assessed immediately after CSII. Homeostasis model assessment of ß-cell function (HOMA-B) and the area under the curve (AUC) of insulin during IVGTT were higher in the remission group (145.4 ± 89.6 vs. 78.5 ± 68.5, P = 0.002, and 1,423.4 ± 523.2 vs. 1,159.5 ± 476.8 pmol · l–1 · min–1, P = 0.044). Change in acute insulin response was also greater in the remission group than that in the nonremission group (621.8 ± 430.4 vs. 387.3 ± 428.8 pmol · l–1 · min–1, P = 0.033).
CONCLUSIONS—Short-term intensive insulin therapy can induce long-term glycemic control in newly diagnosed type 2 diabetic patients with severe hyperglycemia. The improvement of ß-cell function, especially the restoration of first-phase insulin secretion, could be responsible for the remission.
Abbreviations: AIR, acute insulin response • AUC, area under the curve • CSII, continuous subcutaneous insulin infusion • FBG, fasting blood glucose • FFA, free fatty acid • FPG, fasting plasma glucose • HOMA-B, homeostasis model assessment of ß-cell function • HOMA-IR, HOMA of insulin resistance • IVGTT, intravenous glucose tolerance test • PPG, postprandial plasma glucose
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