[The role of insulin reserve in choice of therapy in type 2 diabetes mellitus].
Diagnosing a particular disorder and selecting an adequate therapy in diabetes type 2 is major problem in diabetes science. So far, the most commonly used therapeutic principles have been those that rest upon a clinical testing of glycemia. The assessment of the level of insulin on an empty stomach and of insulin after OGT test provides a better insight into the secretory function of beta cells. The increased levels of insulin on an empty stomach and in 120-th minute of OGT test at an early stage of diabetes type 2 provide a good insight into insulin resistance disorders, whereas the values of the alfa index of stimulation (the level of insulin in the 60-th minute of OGT test/the level of insulin on an empty stomach) point to a disorder in insulin secretion. This research was carried out on a sample of 113 patients with diabetes type 2, selected in accordance with the criteria set by the World Health Organization (WHO) in 1985, at the average age of 55 and with the average duration of diabetes of 10 years. The patients were divided in accordance with the alpha index of stimulation into three subgroups: The patients in the 1 group (alfa index of stimulation > 2.5) have normal or increased levels of fasting plasma insulin, a significant increase of insulin OGT test (p < 0.001), a relative shortage of insulin, they have clinical characteristics of in the 60-th minute of diabetes type 2 and require treatment with oral hypoglycemizing medications. The patients in the II group (alfa index of stimulation < 2.5 > 1.5) have normal or increased levels of fasting plasma insulin, a significant increase of insulin in the 60-th minute of OGT test (p < 0.05), but the increase is smaller than in the first group of patients. They have a relative shortage of insulin and clinical characteristics of diabetes type 2 and require treatment with a combined therapy (insulin + hypoglycemizing medications). The patients in III group(alfa index of stimulation < 1.5) have normal levels of fasting plasma insulin, insignificant increase of insulin in the 60-th minute of OGT test (NS), an absolute shortage of insulin, they have clinical characteristics of diabetes type 2 and require treatment with insulin only. The research results suggest that the application of insulin to blood with OGT test is a safe and efficient method for appraisal of specific disorders and selection of therapy in patients with diabetes type 2. It is possible to draw the conclusion that the group of the patients with the alfa index stimulation > 2.5 requires treatment with oral hypoglycemizing medications alone, or in combination. The group of patients with the alfa index of stimulation #2.5 > 1.5 requires treatment with a combined therapy (insulin + hypoglycemizing medications). The group of patients with the alpha index of stimulation #1.5 require 4s treatment with insulin.
Poljaković
Dzemal
D
Odjeljenje za endokrinologiju, dijabetes i poremećaje metabolizma, Interna klinika UKC Tuzla.
Hajder
Midhat
M
D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D007328:Insulin