Journal Article

Predictors of Long-Term Glycemic Remission After 2-Week Intensive Insulin Treatment in Newly Diagnosed Type 2 Diabetes

Li, Ling, Wang, Hui, Liu, Shiping, Li, Guangwei, Kuang, Jian, Zhao, Weigang, Zhang, Fan, Liang, Zhen, Wang, Yang, Gao, Zhengnan, Yang, Gangyi, Xu, Mingtong, Yu, Yerong, Li, Qifu

2019

Overview

Abstract Context Although several studies suggest that improved β-cell function is a key determinant of glycemic remission in type 2 diabetes, other predictors remain unclear. Objective The aim of this clamp-based study was to identify predictors of 2-year glycemic remission after short-term intensive insulin treatment. Design A 2-year follow-up was planned in 124 drug-naive patients with type 2 diabetes who received continuous subcutaneous insulin infusion (CSII) for 2 weeks. Euglycemic-hyperinsulinemic clamps and IV glucose tolerance tests were performed to assess the insulin sensitivity [glucose infusion rate (GIR)] and acute insulin response (AIR) before and after CSII. Results First-phase insulin secretion was restored, and the GIR was significantly improved (P < 0.0001) after the 2-week CSII. Glycemic remission rates were 47.6% and 30.7% after 12 and 24 months of follow-up, respectively. Cox analysis revealed that a higher post-CSII glucose level [hazard ratio (HR), 1.38; 95% CI, 1.15 to 1.66; P = 0.0005] and older age at diabetes diagnosis (HR, 1.34; 95% CI, 1.05 to 1.72; P = 0.02) accounted for an increased risk of hyperglycemic relapse. A 1 SD increase in the AIR (HR, 0.75; 95% CI, 0.57 to 0.99; P = 0.04), GIR (HR, 0.67; 95% CI, 0.48 to 0.93; P = 0.016) after CSII, and baseline GIR (HR, 0.71; 95% CI, 0.51 to 0.99; P = 0.047) was inversely associated with this risk. Conclusions Younger age at diabetes diagnosis, higher baseline insulin sensitivity, and lower glucose levels after insulin treatment significantly favored a 2-year glycemic remission. This long-term remission was attributed to both improved insulin sensitivity and enhanced β-cell function after short-term intensive insulin treatment. Younger age at diabetes diagnosis, better baseline insulin sensitivity, and improvements of acute insulin secretion and insulin sensitivity after treatment were all predictors of 2-year remission.

• Publisher: Endocrine Society,Copyright Oxford University Press,Oxford University Press
• Subject: Adult / Analysis / Beta cells / Blood Glucose - analysis / Blood sugar monitoring / Dextrose / Diabetes / Diabetes mellitus (non-insulin dependent) / Diabetes Mellitus, Type 2 - blood / Diabetes Mellitus, Type 2 - drug therapy / Diabetes therapy / Diagnosis / Drug development / Female / Glucose / Glucose tolerance / Glucose Tolerance Test / Humans / Infusions, Subcutaneous / Insulin / Insulin - administration & dosage / Insulin aspart / Insulin Resistance / Insulin secretion / Insulin-Secreting Cells - physiology / Male / Middle Aged / Prospective Studies / Remission / Type 2 diabetes