Improvement in insulin sensitivity following intensive insulin therapy and association of glucagon with long-term diabetes remission.
Objective To investigate the role of the acute glucagon response in the long-term remission of newly diagnosed type 2 diabetes mellitus following short-term intensive insulin therapy (IIT). Methods Ten patients with newly diagnosed type 2 diabetes mellitus received IIT. Intravenous glucose tolerance tests and the clamp technique were performed pre- and post-IIT. Remission was defined as maintenance of target glycaemic control without anti-diabetic agents for 1 year. Results The remission rate was 50% (5/10). There were no differences in the acute insulin response or glucose infusion rate between groups. The acute glucagon response (AGR) in the remission group pre-IIT was significantly higher than that in the non-remission group (mean 163.02 pg/mL/min vs. mean 16.29 pg/mL/min). The mean AGR post-IIT was lower in the remission group than that in the non-remission group (0 pg/mL/min vs. 19.91 pg/mL/min). Spearman analysis indicated that the AGR pre-IIT and the change in the AGR were correlated with remission (r = 0.731). Conclusion The insulin-mediated glucose disposal rate was significantly improved with the normalization of blood glucose levels following transient IIT. Subjects with a higher AGR pre-IIT and a greater AGR decrease post-IIT displayed a greater likelihood of long-term remission.
Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China.
Bo
B
Zhang
Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China.
Yan-Yan
YY
Chen
Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China.
Zhao-Jun
ZJ
Yang
Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China.
Xin
X
Wang
Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China.
Guang-Wei
GW
Li
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D005215:Fasting; D005260:Female; D005934:Glucagon / Q000008:administration & dosage / Q000097:blood*; D005951:Glucose Tolerance Test; D006801:Humans; D007004:Hypoglycemic Agents / Q000097:blood / Q000627:therapeutic use*; D007328:Insulin / Q000097:blood / Q000627:therapeutic use*; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D012074:Remission Induction
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D005934:Glucagon
glucagon; insulin sensitivity; intensive insulin therapy; long-term remission; type 2 diabetes mellitus