The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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The Effect of Early Insulin Therapy on Pancreatic ${\beta}$-Cell Function and Long-Term Glycemic Control in Newly Diagnosed Type 2 Diabetic Patients

  • Chon, Suk (Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine) ;
  • Oh, Seung-Joon (Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine) ;
  • Kim, Sung-Woon (Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine) ;
  • Kim, Jin-Woo (Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine) ;
  • Kim, Young-Seol (Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine) ;
  • Woo, Jeong-Taek (Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine)
  • Received : 2009.08.27
  • Accepted : 2010.06.11
  • Published : 2010.09.01
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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 ${\beta}$-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 ${\beta}$-cell function and glycemic control during a 48-month follow-up period. Results: Mean HbA1c decreased significantly as a result of EIT from $10.7{\pm}1.8%$ to $6.2{\pm}1.1%$ (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 ${\beta}$-cell function. Conclusions: Our results suggest that regardless of the method of delivery, EIT significantly improves ${\beta}$-cell function and facilitates long-term glycemic control in patients with newly diagnosed type 2 diabetes mellitus.

Keywords

References

  1. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998;352:837-853. https://doi.org/10.1016/S0140-6736(98)07019-6
  2. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998;352:854-865. https://doi.org/10.1016/S0140-6736(98)07037-8
  3. Kahn SE, Haffner SM, Heise MA, et al. Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy. N Engl J Med 2006;355:2427-2443. https://doi.org/10.1056/NEJMoa066224
  4. Weng J, Li Y, Xu W, et al. Effect of intensive insulin therapy on beta-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomised parallelgroup trial. Lancet 2008;371:1753-1760. https://doi.org/10.1016/S0140-6736(08)60762-X
  5. Wajchenberg BL. beta-cell failure in diabetes and preservation by clinical treatment. Endocr Rev 2007;28:187-218.
  6. Ilkova H, Glaser B, Tunçkale A, Bagriaçik N, Cerasi E. Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients by transient intensive insulin treatment. Diabetes Care 1997;20:1353-1356. https://doi.org/10.2337/diacare.20.9.1353
  7. Li Y, Xu W, Liao Z, et al. Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients is associated with improvement of beta-cell function. Diabetes Care 2004;27:2597-2602. https://doi.org/10.2337/diacare.27.11.2597
  8. Ryan EA, Imes S, Wallace C. Short-term intensive insulin therapy in newly diagnosed type 2 diabetes. Diabetes Care 2004;27:1028-1032. https://doi.org/10.2337/diacare.27.5.1028
  9. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412-419. https://doi.org/10.1007/BF00280883
  10. Phillips DI, Clark PM, Hales CN, Osmond C. Understanding oral glucose tolerance: comparison of glucose or insulin measurements during the oral glucose tolerance test with specific measurements of insulin resistance and insulin secretion. Diabet Med 1994;11: 286-292. https://doi.org/10.1111/j.1464-5491.1994.tb00273.x
  11. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157-163. https://doi.org/10.1016/S0140-6736(03)15268-3
  12. Nathan DM, Buse JB, Davidson MB, et al. Management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy. A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2006;29:1963-1972. https://doi.org/10.2337/dc06-9912
  13. Hirao K, Arai K, Yamauchi M, Takagi H, Kobayashi M; Japan Diabetes Clinical Data Management Study Group. Six-month multicentric, open-label, randomized trial of twice-daily injections of biphasic insulin aspart 30 versus multiple daily injections of insulin aspart in Japanese type 2 diabetic patients (JDDM 11). Diabetes Res Clin Pract 2008;79:171-176. https://doi.org/10.1016/j.diabres.2007.08.011
  14. McFarlane SI, Chaiken RL, Hirsch S, Harrington P, Lebovitz HE, Banerji MA. Near-normoglycaemic remission in African- Americans with Type 2 diabetes mellitus is associated with recovery of beta cell function. Diabet Med 2001;18:10-16.
  15. Retnakaran R, Drucker DJ. Intensive insulin therapy in newly diagnosed type 2 diabetes. Lancet 2008;371:1725-1726. https://doi.org/10.1016/S0140-6736(08)60736-9
  16. Gleason CE, Gonzalez M, Harmon JS, Robertson RP. Determinants of glucose toxicity and its reversibility in the pancreatic islet betacell line, HIT-T15. Am J Physiol Endocrinol Metab 2000;279: E997-E1002.
  17. Yki-Jarvinen H, Esko N, Eero H, Marja-Riitta T. Clinical benefits and mechanisms of a sustained response to intermittent insulin therapy in type 2 diabetic patients with secondary drug failure. Am J Med 1988;84:185-192. https://doi.org/10.1016/0002-9343(88)90412-3
  18. Samanta A, Burden AC, Jones GR, Clarkson L. The effect of short term intensive insulin therapy in non-insulin-dependent diabetics who had failed on sulphonylurea therapy. Diabetes Res 1986;3: 269-271.
  19. Glaser B, Leibovich G, Nesher R, Hartling S, Binder C, Cerasi E. Improved beta-cell function after intensive insulin treatment in severe non-insulin-dependent diabetes. Acta Endocrinol (Copenh) 1988;118:365-373.
  20. Turner RC, Cull CA, Frighi V, Holman RR. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). UK Prospective Diabetes Study (UKPDS) Group. JAMA 1999;281:2005-2012. https://doi.org/10.1001/jama.281.21.2005
  21. Hansen TK, Thiel S, Wouters PJ, Christiansen JS, Van den Berghe G. Intensive insulin therapy exerts antiinflammatory effects in critically ill patients and counteracts the adverse effect of low mannose-binding lectin levels. J Clin Endocrinol Metab 2003;88:1082-1088. https://doi.org/10.1210/jc.2002-021478
  22. He QH, Zhou YS, Wang Z, et al. Improvement of the function of islet beta and alpha cells by intervention against glucotoxicity: experiment with rats. Zhonghua Yi Xue Za Zhi 2008;88:374-377.
  23. Garvey WT, Olefsky JM, Griffin J, Hamman RF, Kolterman OG. The effect of insulin treatment on insulin secretion and insulin action in type II diabetes mellitus. Diabetes 1985;34:222-234. https://doi.org/10.2337/diabetes.34.3.222
  24. Rhee MK, Slocum W, Ziemer DC, et al. Patient adherence improves glycemic control. Diabetes Educ 2005;31:240-250. https://doi.org/10.1177/0145721705274927
  25. Kennedy L, Herman WH, Strange P, Harris A; GOAL AIC Team. Impact of active versus usual algorithmic titration of basal insulin and point-of-care versus laboratory measurement of HbA1c on glycemic control in patients with type 2 diabetes: the Glycemic Optimization with Algorithms and Labs at Point of Care (GOAL A1C) trial. Diabetes Care 2006;29:1-8. https://doi.org/10.2337/diacare.29.01.06.dc05-1058
  26. Ovalle F, Bell DS. Effect of rosiglitazone versus insulin on the pancreatic beta-cell function of subjects with type 2 diabetes. Diabetes Care 2004;27:2585-2589. https://doi.org/10.2337/diacare.27.11.2585
  27. Alvarsson M, Sundkvist G, Lager I, et al. Effects of insulin vs. glibenclamide in recently diagnosed patients with type 2 diabetes: a 4-year follow-up. Diabetes Obes Metab 2008;10:421-429. https://doi.org/10.1111/j.1463-1326.2007.00719.x
  28. Miller FG, Rosenstein DL. The therapeutic orientation to clinical trials. N Engl J Med 2003;348:1383-1386. https://doi.org/10.1056/NEJMsb030228
  29. Appelbaum PS, Roth LH, Lidz CW, Benson P, Winslade W. False hopes and best data: consent to research and the therapeutic misconception. Hastings Cent Rep 1987;17:20-24.
  30. Lidz CW, Appelbaum PS. The therapeutic misconception: problems and solutions. Med Care 2002;40(9 Suppl):V55-V63.
  31. Miller PB, Weijer C. Trust based obligations of the state and physician-researchers to patient-subjects. J Med Ethics 2006;32: 542-547. https://doi.org/10.1136/jme.2005.014670
  32. Charuvastra A, Marder SR. Unconscious emotional reasoning and the therapeutic misconception. J Med Ethics 2008;34:193-197. https://doi.org/10.1136/jme.2006.018960

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