title: Improved glycemic control in pancreatic diabetes through intensive conservative insulin therapy.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effectivity and safety of insulin therapy in patients with DM secondary to underlying chronic pancreatitis with initially inappropriate glycemic control.
  
  
  METHODS
  Pancreatic DM patients treated with oral antidiabetics (OAD) or pre-mixed insulin (PMI) with HbA1c ≥7.0% were recruited. Intensive conservative insulin treatment (ICT) (Group A, n = 16) or PMI (Group B, n = 8) was introduced instead of OAD, or the initial PMI therapy was switched to ICT (Group C, n = 10). The changes in HbA1c, fasting plasma glucose, body weight and hypoglycemic events from baseline to 2 years were followed.
  
  
  RESULTS
  The patients in Group A and B had been treated with oral antidiabetics for 55 ± 68 months before switching to insulin therapy. The level of HbA1c had worsened from 8.3 ± 1.5% to 9.8 ± 1.7% during this period. The ICT had reduced HbA1c significantly from 9.7 ± 1.8% to 7.6 ± 1.4% after 12 weeks, in Group A, and five patients had HbA1c<7.0%. The introduction of PMI in Group B reduced HbA1c from 10.0 ± 1.4% to 9.0 ± 0.6% by 12 weeks. None of the patients had HbA1c<7.0%. By 12 weeks, the introduction of ICT in Group C had reduced the level of HbA1c from 8.8 ± 1.7% to 7.7 ± 1.2%. Two patients reached HbA1c<7.0%. There were two severe hypoglycemic episodes during the 2 years, one-one case in Group A and B.
  
  
  CONCLUSIONS
  Oral medication becomes insufficient early in pancreatic DM. Long-term improvement of glycemic control can be achieved through intensified insulin therapy and in selected cases through PMI with a low risk of hypoglycemia.
authors.affiliation: First Department of Medicine, University of Szeged, Szeged, P.O. Box 427, H-6701, Hungary.
authors.forename: Viktória
authors.initials: V
authors.lastname: Terzin
authors.forename: Róbert
authors.initials: R
authors.lastname: Takács
authors.forename: Csaba
authors.initials: C
authors.lastname: Lengyel
authors.forename: Tamás
authors.initials: T
authors.lastname: Várkonyi
authors.forename: Tibor
authors.initials: T
authors.lastname: Wittmann
authors.forename: Attila
authors.initials: A
authors.lastname: Pálinkás
authors.forename: László
authors.initials: L
authors.lastname: Czakó
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D001835:Body Weight / Q000187:drug effects; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D057915:Drug Substitution; D005215:Fasting; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D061266:Insulin, Short-Acting / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000097:blood / Q000150:complications / Q000188:drug therapy*
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D061266:Insulin, Short-Acting; C517652:hemoglobin A1c protein, human