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Insulin secretion predicts the response to therapy with exenatide plus pioglitazone, but not to basal/bolus insulin in poorly controlled T2DM patients: Results from the Qatar study
Author(s) -
AbdulGhani Muhammad,
Migahid Osama,
Megahed Ayman,
Singh Rajvir,
Kamal Dalia,
DeFronzo Ralph A.,
Jayyousi Amin
Publication year - 2018
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.13189
Subject(s) - pioglitazone , exenatide , medicine , insulin , sulfonylurea , endocrinology , metformin , bolus (digestion) , basal (medicine) , basal insulin , type 2 diabetes , diabetes mellitus
The present study aims to identify predictors for response to combination therapy with pioglitazone plus exenatide vs basal/bolus insulin therapy in T2DM patients who are poorly controlled with maximum/near‐maximum doses of metformin plus a sulfonylurea. Participants in the Qatar study received a 75‐g OGTT with measurement of plasma glucose, insulin and C‐peptide concentration at baseline and were then randomized to receive either treatment with pioglitazone plus exenatide or basal/bolus insulin therapy for one year. Insulin secretion measured with plasma C‐peptide concentration during the OGTT was the strongest predictor of response to combination therapy (HbA1c ≤ 7.0%) with pioglitazone plus exenatide. A 54% increase in 2‐hour plasma C‐peptide concentration above the fasting level identified subjects who achieved the glycaemic goal (HbA1c < 7.0%) with 82% sensitivity and 79% specificity. Only baseline HbA1c was a predictor of response to basal/bolus insulin therapy. Thus, the increment in 2‐hour plasma C‐peptide concentration above the fasting level provides a useful tool to identify poorly controlled T2DM patients who can achieve glycaemic control without insulin therapy, and thereby, can be used to individualize antihyperglycaemic therapy in poorly controlled T2DM patients.