title: Factors associated with improvement of fasting plasma glucose level by mealtime dosing of a rapid-acting insulin analog in type 2 diabetes.
abstract: This study investigated whether strict control of plasma glucose levels with mealtime dosing of a rapid-acting insulin analog improves early morning fasting plasma glucose (FPG) levels in patients with type 2 diabetes. A rapid-acting insulin analog was administered at each mealtime to 40 Japanese patients with type 2 diabetes whose existing antidiabetic medication was discontinued. Approximately one-half (52.5%) of the patients achieved a minimum early morning FPG levels achievable (nadir FPG) of <120mg/dL with mealtime dosing of a rapid-acting insulin analog alone; no basal insulin replacement was needed in these patients. Nadir FPG levels were independent of duration of diabetes, baseline body mass index (BMI) or glycemic control. All patients who had been treated with sulfonylureas needed basal insulin replacement. Low responses of insulin to glucagon and to arginine, and high response of glucagon to arginine may explain the failure to improve FPG levels with postprandial insulin replacement alone. In conclusion, approximately one-half of the patients with type 2 diabetes achieved appropriate control of FPG by rapid-acting insulin analog monotherapy. Basal insulin secretory defects in type 2 diabetes may be estimated by the responses of insulin to glucagon and to arginine and the response of glucagon to arginine. This study contributes to a better understanding of the pathophysiology contributing to the heterogeneity in the characteristics of insulin secretion in type 2 diabetes.
authors.affiliation: Department of Disease Control and Homeostasis, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Ishikawa 920-8641, Japan. ttakamura@m-kanazawa.jp
authors.forename: Toshinari
authors.initials: T
authors.lastname: Takamura
authors.forename: Masaru
authors.initials: M
authors.lastname: Sakurai
authors.forename: Masumi
authors.initials: M
authors.lastname: Nakamura
authors.forename: Akiko
authors.initials: A
authors.lastname: Shimizu
authors.forename: Tsuguhito
authors.initials: T
authors.lastname: Ota
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Misu
authors.forename: Yumie
authors.initials: Y
authors.lastname: Takeshita
authors.forename: Naomi
authors.initials: N
authors.lastname: Tsuchiyama
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Kurita
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ando
authors.forename: Shuichi
authors.initials: S
authors.lastname: Kaneko
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D002096:C-Peptide / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004435:Eating; D005215:Fasting; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D061389:Insulin, Regular, Pork; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D061389:Insulin, Regular, Pork; C000006:insulin, neutral