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Insulin requirement profiles of short-term intensive insulin therapy in patients with newly diagnosed type 2 diabetes and its association with long-term glycemic remission

Published:February 21, 2015DOI:https://doi.org/10.1016/j.diabres.2015.02.011

      Highlights

      • There is a decline of daily insulin dose after euglycemia achieved.
      • The decrement of daily insulin dose is related to reduction of insulin resistance during the therapy.
      • Patients with lowest decline of insulin dose had higher risk of hyperglycemic relapse.

      Abstract

      Aims

      To investigate the insulin requirement profiles during short-term intensive continuous subcutaneous insulin infusion (CSII) in patients with newly diagnosed type 2 diabetes and its relationship with long-term glycemic remission.

      Methods

      CSII was applied in 104 patients with newly diagnosed type 2 diabetes. Daily insulin doses were titrated and recorded to achieve and maintain euglycemia for 2 weeks. Measurements of blood glucose, lipid profiles as well as intravenous glucose tolerance tests were performed before and after the therapy. Afterwards, patients were followed up for 1 year.

      Results

      Total daily insulin dose (TDD) was 56.6 ± 16.1 IU at the first day when euglycemia was achieved (TDD-1). Thereafter, TDD progressively decreased at a rate of 1.4 ± 1.0 IU/day to 36.2 ± 16.5 IU at the end of the therapy. TDD-1 could be estimated with body weight, FPG, triglyceride and waist circumference in a multiple linear regression model. Decrement of TDD after euglycemia was achieved (ΔTDD) was associated with reduction of HOMA-IR (r = 0.27, P = 0.008) but not with improvement in β cell function. Patients in the lower tertile of ΔTDD had a significantly higher risk of hyperglycemia relapse than those in the upper tertile within 1 year (HR 3.4, 95%CI [1.4, 8.4], P = 0.008).

      Conclusions

      There is a steady decline of TDD after euglycemia is achieved in patients with newly diagnosed type 2 diabetes treated with CSII, and ΔTDD is associated with a better long-term glycemic outcome.

      Keywords

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