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The response to short‐term intensive insulin therapy in type 2 diabetes
Author(s) -
Retnakaran R.,
Yakubovich N.,
Qi Y.,
Opsteen C.,
Zinman B.
Publication year - 2010
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/j.1463-1326.2009.01129.x
Subject(s) - medicine , diabetes mellitus , type 2 diabetes , insulin , area under the curve , gastroenterology , endocrinology
Aim: Although a short course of intensive insulin therapy (IIT) can improve beta‐cell function and glycaemic control in most patients with newly diagnosed type 2 diabetes (T2DM), the impact of this intervention in diabetes of longer duration has not been carefully studied. Thus, we sought to evaluate the effect of short‐term IIT in patients with established T2DM. Methods: Thirty‐four patients, with diabetes of mean 5.9 ± 6.6 years duration, underwent 4–8 weeks of IIT, with 4‐h meal test administered at baseline and at 1 day post‐IIT. A positive clinical response was defined as fasting glucose < 7.0 mmol/l off any antidiabetic therapy at the latter test. Results: A positive response was achieved in 68% (n = 23) of the subjects. At baseline meal test, the responders had lower glucose levels than the non‐responders from 120 to 240 min (all timepoints p ≤ 0.0008) and higher late incremental area‐under‐the‐C‐peptide‐curve (AUC Cpep ), particularly from 60 to 150 min (all p < 0.005). Beta‐cell function (ratio of AUC Cpep to AUC gluc divided by HOMA‐IR) was similar between the groups at baseline (median 54.1 vs. 51.3, p = 0.62) but after IIT was significantly higher in the responders (109.3 vs. 57.4, p = 0.009). At baseline, the strongest predictors of the change in beta‐cell function were glucose levels between 180 and 240 min (all r = −0.5, p = 0.005) and incremental AUC Cpep from 120 to 180 min (all r ≥ 0.66, p ≤ 0.0001), both reflecting late‐phase insulin secretion. Conclusions: The clinical response to short‐term IIT is variable, consistent with the heterogeneity of T2DM. However, preserved late‐phase insulin secretion may identify those patients who can benefit from this intervention with improved beta‐cell function.