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Effect of Intensive Insulin Therapy in Early Type 2 Diabetes on Glycemic Variability

Short course of intensive insulin therapy can impact beta-cell function and glucose variability…. 

Acute oscillations in blood glucose are associated with negative outcomes in diabetes. Many believe such oscillations may be a significant risk factor for diabetes complications beyond the average glycemic exposure.

According to a new study, short-term intensive insulin therapy can improve beta-cell function in type 2 diabetes and decrease glycemic variability. Researchers from Mount Sinai Hospital in Toronto examined whether beta-cell functional recovery induced by short-term intensive insulin therapy correlated with glycemic variability. A total of 61 study participants who had had type 2 diabetes for an average duration of 3 years, underwent intensive insulin therapy for a total of 4 weeks after completely stopping all anti-diabetic medications. Intensive insulin therapy included basal insulin detemir and premeal insulin aspart with starting total daily doses of 0.2–0.4 units per kg (60% bolus and 40% basal). Study participants performed self-monitoring of capillary blood glucose (SMBG) at least 4 times daily. Insulin doses were titrated to target fasting blood glucose (4.0 and 6.0 mmol/L) and 2-hour postprandial glucose (<8 mmol/L) by a specially trained nurse after receiving SMBG records from study participants on at least 3 occasions per week.

Before and after the intervention, researchers assessed pancreatic beta-cell function using the Insulin Secretion-Sensitivity Index-2 (ISSI-2). Researchers also measured glucose variability using the coefficient of variation of capillary glucose from the 6-point self-monitoring profiles.

Between the first and last week on intensive insulin therapy, researchers found 55.7% of patients had a reduction in their glucose variability. A negative correlation was found between the change in glucose variability and change in beta-cell function (r=-0.34, P = 0.008). The only factor independently associated with the change in glucose variability was percentage change in the Insulin Secretion-Sensitivity Index-2 (standardized beta = −0.42, P = 0.03). In study participants having a 25% or larger increase in the Insulin Secretion-Sensitivity Index-2 experienced a reduction in glucose variability when compared to their peers (−0.041 and −0.0002; P = 0.006), respectively.

Practice Pearls:
  • Variability in blood glucose levels is believed to have a negative impact on diabetes-related complications
  • Interventions early in the course of diabetes have the potential for reducing potential adverse outcomes associated with increased glycemic variability
  • Further studies need to be done to assess the clinical implications of short-term intensive insulin therapy as well as the impact of different regimens

Kramer CK, Choi H, Zinman B, Retnakaran R. Glycemic Variability in Patients With Early Type 2 Diabetes: The Impact of Improvement in β-Cell Function. Diabetes Care. 2014;37(4):1116-23.