Remission of hyperglycemia following intensive insulin therapy in newly diagnosed type 2 diabetic patients: a long-term follow-up study

doi:
10.3760/cma.j.issn.0366-6999.2009.21.006
Abstract:
Background Early intensive insulin therapies in newly diagnosed type 2 diabetic patients may improve β-cell function and yield prolonged glycemic remissions. This study was performed to evaluate the relationship between the glycemic remission and p-cell function and assess the variables predictive of long-term near-normoglycemic remission. Methods Eighty-four newly diagnosed type 2 diabetic patients were treated with 2-week continuous subcutaneous insulin infusion (CSII) and followed up longitudinally. Intravenous glucose tolerance tests (IVGTTs) were performed, and blood glucose, hemoglobin A1c (HbA1c) and insulin were measured at baseline, after CSII and at 2-year visit. The patients who maintained glycemic control for two years were defined as the remission group and those who relapsed before the 2-year visit were the non-remission group. Results The duration to be diagnosed of the patients (from the time that patients began to have diabetic symptoms until diagnosis) in the remission group was shorter than that in the non-remission group (1.00 month vs 4.38 months, P=0.040). The increase of the acute insulin response (AIR) was maintained after 2 years in the remission group compared with AIR measured immediately after intervention (413.05 pmol·L~(-1)·min~(-1) vs 408.99 pmol·L~(-1)·min~(-1), P=0.820). While AIR in the non-remission group significantly declined (74.71 pmol·L~(-1)·min~(-1) vs 335.64 pmol·L~(-1)·min~(-1), P=0.030). Cox model showed that a shorter duration to be diagnosed positively affected the duration of near-nomoglycemic remission with an odds ratio (OR) 1.019, P=0.038, while fasting plasma glucose (FPG) and post-breakfast plasma glucose (PPG) after CSII were the risk factors (OR 1.397, P = 0.024 and OR 1.187, P = 0.035, respectively). Conclusion The near-normoglycemic remission is closely associated with long-term maintenance of p-cell function and occurs more commonly in patients with shorter duration to be diagnosed and better glycemic control during CSII.
作者
Author: XU Wen[1]    LI Yan-bing[1]    DENG Wan-ping[1]    HAO Yuan-tao[2]    WENG Jian-ping[3]
作者单位
  1. Department of Endocrinology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
  2. Department of Medical Statistics and Epidemiology,School of Public Health,Sun Yat-sen University,Guangzhou,Guangdong 510080,China
  3. Department of Endocrinology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China;Department of Endocrinology,Third Affiliated Hospital of Sun Yat-sen University,Guangzhou,Guangdong 510630,China
刊 名: 中华医学杂志(英文版)   ISTICSCI
Journal: CHINESE MEDICAL JOURNAL
年,卷(期) 2009, (21)
分类号 R5
Keywords: type 2 diabetes mellitus 知识脉络    insulin 知识脉络    remission 知识脉络    follow-up 知识脉络   
机标分类号 R97 R96
基金项目 This work was supported by the grants from the Ministry of Health of the People's Republic of China for Key Projects of Clinical Disciplines of Hospitals Affiliated to Ministry of Health(2007-2009),Scientific and Technological Project of Guangdong Province,Sun Yat-sun University Clinical Research 5010 Program
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