Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients is associated with improvement of beta-cell function.
OBJECTIVE
To investigate 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.


METHODS
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, HbA(1c), lipid profiles, proinsulin, insulin, and C-peptide were measured before and after CSII. Patients were followed longitudinally on diet alone after withdrawal of insulin.


RESULTS
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 beta-cell function than those who did not (nonremission group) when assessed immediately after CSII. Homeostasis model assessment of beta-cell function (HOMA-B) and the area under the curve (AUC) of insulin during IVGTT were higher in the remission group (145.4 +/- 89.6 vs. 78.5 +/- 68.5, P = 0.002, and 1,423.4 +/- 523.2 vs. 1,159.5 +/- 476.8 pmol x l(-1) x min(-1), P = 0.044). Change in acute insulin response was also greater in the remission group than that in the nonremission group (621.8 +/- 430.4 vs. 387.3 +/- 428.8 pmol x l(-1) x min(-1), P = 0.033).


CONCLUSIONS
Short-term intensive insulin therapy can induce long-term glycemic control in newly diagnosed type 2 diabetic patients with severe hyperglycemia. The improvement of beta-cell function, especially the restoration of first-phase insulin secretion, could be responsible for the remission.
Li
Yanbing
Y
Department of Endocrinology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China 510080.
Xu
Wen
W
Liao
Zhihong
Z
Yao
Bin
B
Chen
Xiahua
X
Huang
Zhimin
Z
Hu
Guoliang
G
Weng
JianPing
J
D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006706:Homeostasis; D006801:Humans; D007328:Insulin / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use; D007332:Insulin Infusion Systems; D007333:Insulin Resistance; D007515:Islets of Langerhans / Q000503:physiopathology*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D012074:Remission Induction
D001786:Blood Glucose; D007328:Insulin; D008055:Lipids