Induction of Long-term Glycemic Control in Newly Diagnosed Type 2 Diabetic Patients Is Associated With Improvement of β-Cell Function
- Yanbing Li, MD,
- Wen Xu, MD,
- Zhihong Liao, MD, PHD,
- Bin Yao, MD,
- Xiahua Chen, MD,
- Zhimin Huang, MD,
- Guoliang Hu, MD and
- JianPing Weng, MD, PHD
- 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
Abstract
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 β-cell function than those who did not (nonremission group) when assessed immediately after CSII. Homeostasis model assessment of β-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 β-cell function, especially the restoration of first-phase insulin secretion, could be responsible for the remission.
- 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 β-cell function
- HOMA-IR, HOMA of insulin resistance
- IVGTT, intravenous glucose tolerance test
- PPG, postprandial plasma glucose
Footnotes
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A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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- Accepted August 17, 2004.
- Received June 28, 2004.
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