Long-term Glycemic Control in Newly Diagnosed Type 2 Diabetic Patients Is Associ

Starting newly diagnosed Type 2 patients on insulin can improve long term glucose control due to the restoration of first-phase insulin secretion. The study investigated whether long-term optimal glycemic control can be achieved without medication by transient continuous subcutaneous insulin infusion (CSII) and the possible mechanisms responsible for this remission.

Newly diagnosed type 2 diabetic patients (n = 138, fasting glucose >11.1mmol/l) were hospitalized and treated with CSII for 2 weeks. Intravenous glucose tolerance tests (IVGTTs) were performed, and blood glucose, HbA1c, lipid profiles, proinsulin, insulin, and C-peptide were measured before and after CSII. Patients were followed longitudinally on diet alone after withdrawal of insulin.

The results showed that optimal glycemic control was achieved within 6.3 ± 3.9 days by CSII in 126 patients. The remission rates (percentages maintaining near euglycemia) at the third, sixth, twelfth, and twenty-fourth month were 72.6, 67.0, 47.1, and 42.3%, respectively. Patients who maintained glycemic control >12 months (remission group) had greater recovery of ß-cell function than those who did not (nonremission group) when assessed immediately after CSII. Homeostasis model assessment of ß-cell function (HOMA-B) and the area under the curve (AUC) of insulin during IVGTT were higher in the remission group. Change in acute insulin response was also greater in the remission group than that in the nonremission group.

From the results of the study it was concluded that short-term intensive insulin therapy can induce long-term glycemic control in newly diagnosed type 2 diabetic patients with severe hyperglycemia. The improvement of ß-cell function, especially the restoration of first-phase insulin secretion, could be responsible for the remission.

Diabetes Care 27:2597-2602, 2004

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