Staged diabetes management according to individual patient insulin resistance and beta-cell function ameliorates glycaemic control in type 2 diabetes mellitus.
OBJECTIVE
The current consensus algorithm for management of type 2 diabetes is based on the fasting glucose concentration and glycated haemoglobin A(1c) (HbA(1c)) level. We applied a new therapeutic strategy by assessing insulin secretion and insulin resistance, in addition to glucose concentrations in individual patients.


METHODS
We enrolled 193 patients with type 2 diabetes. The patients were assigned to one of six groups according to insulin secretion measured by the serum fasting C-peptide concentration and insulin resistance measured by an insulin tolerance test (ITT). The two groups were treated differently: 108 patients were treated using a new staged diabetes management (SDM) strategy and 85 patients continued with conventional therapy.


METHODS
We compared metabolic variables in the two groups at baseline and 12 months after enrollment.


RESULTS
In patients treated with the SDM strategy, fasting glucose concentration decreased from 9.8 +/- 2.1 to 8.2 +/- 1.7 mmol/l (P < 0.001). Postprandial 2-h glucose concentration decreased from 14.19 +/- 3.34 to 12.27 +/- 3.24 mmol/l (P < 0.001). HbA(1c) level decreased from 8.37 +/- 1.42% to 7.72 +/- 1.39% (P < 0.001). About 43% of the new SDM group achieved an HbA(1c) of < 7.0% compared with 25% of patients in the conventional treatment group.


CONCLUSIONS
The new SDM strategy, based on individual data on insulin resistance and insulin secretion, may provide valuable clinical benefits in non-obese Korean patients with type 2 diabetes.
Choi
Sung Hee
SH
Department of Internal Medicine, Seoul National University College of Medicine, Bundang Hospital, Seongnam, Korea.
Hur
Kyu Yeon
KY
Kim
Dae Jung
DJ
Ahn
Chul Woo
CW
Kang
Eun Seok
ES
Cha
Bong Soo
BS
Lim
Sung Kil
SK
Huh
Kap Bum
KB
Lee
Hyun Chul
HC
D000368:Aged; D000465:Algorithms; D001786:Blood Glucose / Q000378:metabolism*; D001837:Body Weights and Measures; D002985:Clinical Protocols / Q000592:standards; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D005215:Fasting / Q000097:blood / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007206:Individuality; D007333:Insulin Resistance / Q000502:physiology*; D050417:Insulin-Secreting Cells / Q000502:physiology*; D008297:Male; D008875:Middle Aged
D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human