title: Remission of insulin requirement in late secondary failure to oral hypoglycemic agents (IRD): results at 24 months and analysis of predictive factors.
abstract: Over the last four years, we have done a prospective study of insulin requiring diabetes (IRD). We offered 59 patients insulin therapy during 10 to 14 days by means of continuous subcutaneous insulin injection with the help of a pump in order to maintain the patient under oral hypoglycemic agents (OHA). We divided our population into two characteristic groups and isolated parameters that were predictive of post-insulin therapy evolution by means of C peptide assays. In one group, in 50% of cases, endogenous insulin production appeared impaired and could not be restored by insulin therapy. The patients in this group suffered a renewed drug failure within 3 months. In the other group, 50% of cases, endogenous insulin production was preserved and the CP/blood glucose level ratio improved. On insulin treatment interruption, we observed a significantly improved fasting blood glucose level and we observed decreased insulin needs. The patients, who were probably insulin resistant, suffered only late failures or went into remission, often for longer than one year. The data bring us to the logical conclusion of IRD heterogeneity. Only some of these patients can benefit from temporary insulin therapy and the remission attempt should be limited to them.
authors.affiliation: Clinique Médicale, Hôpital Robert Debré, Reims, France.
authors.forename: H
authors.initials: H
authors.lastname: Grulet
authors.forename: A
authors.initials: A
authors.lastname: Gross
authors.forename: C
authors.initials: C
authors.lastname: Pasqual
authors.forename: V
authors.initials: V
authors.lastname: Durlach
authors.forename: M
authors.initials: M
authors.lastname: Leutenegger
mesh_terms: D015415:Biomarkers / Q000097:blood / Q000652:urine; D001786:Blood Glucose / Q000032:analysis; D001835:Body Weight; D002096:C-Peptide / Q000097:blood / Q000652:urine; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy / Q000652:urine; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged; D009765:Obesity; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D002096:C-Peptide; D007004:Hypoglycemic Agents