title: Staged diabetes management according to individual patient insulin resistance and beta-cell function ameliorates glycaemic control in type 2 diabetes mellitus.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Bundang Hospital, Seongnam, Korea.
authors.forename: Sung Hee
authors.initials: SH
authors.lastname: Choi
authors.forename: Kyu Yeon
authors.initials: KY
authors.lastname: Hur
authors.forename: Dae Jung
authors.initials: DJ
authors.lastname: Kim
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Ahn
authors.forename: Eun Seok
authors.initials: ES
authors.lastname: Kang
authors.forename: Bong Soo
authors.initials: BS
authors.lastname: Cha
authors.forename: Sung Kil
authors.initials: SK
authors.lastname: Lim
authors.forename: Kap Bum
authors.initials: KB
authors.lastname: Huh
authors.forename: Hyun Chul
authors.initials: HC
authors.lastname: Lee
mesh_terms: 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
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human