The effect of early insulin therapy on pancreatic β-cell function and long-term glycemic control in newly diagnosed type 2 diabetic patients - PubMed (original) (raw)

The effect of early insulin therapy on pancreatic β-cell function and long-term glycemic control in newly diagnosed type 2 diabetic patients

Suk Chon et al. Korean J Intern Med. 2010 Sep.

Abstract

Background/aims: Based on the results of well designed clinical studies, intensive insulin therapy has been established to improve glycemic control in newly diagnosed diabetes. However, discrepancies exist between the findings of clinical trials and experiences in general practice. Furthermore, the efficacy of an early insulin therapy (EIT) - commonly used in general practice - on long-term glycemic control has not been established. Therefore, we evaluated the effects of EIT on pancreatic β-cell function and glycemic control using insulin-based methods widely employed in general practice.

Methods: We performed a retrospective cohort study that initially involved reviewing patients' medical records. Following a thorough review, 61 patients who received either biphasic or prandial EIT at the time of diagnosis were enrolled. We then evaluated changes in β-cell function and glycemic control during a 48-month follow-up period.

Results: Mean HbA1c decreased significantly as a result of EIT from 10.7 ± 1.8% to 6.2 ± 1.1% (p < 0.001). On average, 2.6 months was required to achieve an HbA1c value < 7%. EIT significantly improved the insulinogenic index. Glycemic control was well maintained for 48 months. More than 70% of patients were able to maintain glycemic control following lifestyle modifications or treatment with oral antidiabetic drugs. No significant differences were identified between patients receiving biphasic EIT and prandial EIT in terms of glycemic control or pancreatic β-cell function.

Conclusions: Our results suggest that regardless of the method of delivery, EIT significantly improves β-cell function and facilitates long-term glycemic control in patients with newly diagnosed type 2 diabetes mellitus.

Keywords: Diabetes mellitus, type 2; Insulin; Insulin-secreting cells.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1

Changes in HbA1c following early insulin therapy (EIT). Immediately following EIT, glycemic control improved significantly (p < 0.001); the improvement was maintained during the follow-up period.

Figure 2

Changes in β-cell function following early insulin therapy (EIT). Insulinogenic index (A) and acute C-peptide response (B) increased significantly following EIT (p < 0.001). Solid lines indicate median values, and dashed lines denote mean values. Data are presented as the median (interquartile range).

Figure 3

Changes in treatment modality during the 4-year follow-up period. OAD, oral antidiabetic drugs.

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The effect of early insulin therapy on pancreatic β-cell function and long-term glycemic control in newly diagnosed type 2 diabetic patients - PubMed (original) (raw)