Clinical predictors and time course of the improvement in β-cell function with short-term intensive insulin therapy in patients with Type 2 diabetes

2015 ◽  
Vol 32 (5) ◽  
pp. 645-652 ◽  
Author(s):  
C. M. Stein ◽  
C. K. Kramer ◽  
B. Zinman ◽  
H. Choi ◽  
C. Opsteen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Therapy ◽  
Intensive Insulin Therapy ◽  
Time Course ◽  
Cell Function ◽  
Clinical Predictors ◽  
Β Cell ◽  
Short Term ◽  
Β Cell Function

Determinants of reversibility of β-cell dysfunction in response to short-term intensive insulin therapy in patients with early type 2 diabetes

2013 ◽  
Vol 305 (11) ◽  
pp. E1398-E1407 ◽  
Author(s):  
Caroline Kaercher Kramer ◽  
Haysook Choi ◽  
Bernard Zinman ◽  
Ravi Retnakaran
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Therapy ◽  
Intensive Insulin Therapy ◽  
Cell Function ◽  
Sensitivity Index ◽  
Β Cell ◽  
Short Term ◽  
Cell Dysfunction ◽  
Β Cell Function

Short-term intensive insulin therapy (IIT) can improve pancreatic β-cell function when administered early in the course of type 2 diabetes mellitus (T2DM). However, the degree of improvement in response to this therapy varies between patients. Thus, we sought to characterize the determinants of improvement in β-cell function in response to short-term IIT in early T2DM. Sixty-three patients with mean 3.0 ± 2.1 yr duration of T2DM and Hb A1c of 6.8 ± 0.8% underwent 4 wk of IIT consisting of basal insulin detemir and premeal insulin aspart, with oral glucose tolerance test administered at baseline and 1 day post-IIT. β-Cell function before and after IIT was assessed by Insulin Secretion Sensitivity Index-2 (ISSI-2). Reversibility of β-cell dysfunction was defined as percentage change in ISSI-2 of ≥25%. Overall, the study population experienced an increase in ISSI-2 from baseline to post-IIT ( P = 0.01), with one-third of participants achieving ≥25% improvement in ISSI-2. Compared with their peers, those with increases in ISSI-2 of ≥25% had greater decrements in fasting glucose ( P < 0.0001), Hb A1c ( P = 0.001), ALT ( P = 0.04), AST ( P = 0.02), and HOMA-IR ( P < 0.0001). On logistical regression analysis, baseline Hb A1c (OR = 2.83, 95% CI 1.16–6.88, P = 0.02) and change in HOMA-IR (OR = 0.008, 95%CI 0.0004–0.16, P = 0.001) emerged as independent predictors of reversibility of β-cell dysfunction. Indeed, reversibility of β-cell dysfunction was achieved in only those participants in whom IIT yielded an improvement in HOMA-IR. In conclusion, decline in HOMA-IR may be a key determinant of improvement of β-cell function in response to short-term IIT, suggesting a fundamental contribution of insulin resistance to the reversible component of β-cell dysfunction in early T2DM.

scholarly journals Effect of short-term intensive insulin therapy on α-cell function in patients with newly diagnosed type 2 diabetes

Medicine ◽  
2020 ◽  
Vol 99 (14) ◽  
pp. e19685
Author(s):  
Hai-Lan Zheng ◽  
Yan Xing ◽  
Fan Li ◽  
Wei Ding ◽  
Shan-Dong Ye
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Therapy ◽  
Intensive Insulin Therapy ◽  
Cell Function ◽  
Newly Diagnosed ◽  
Short Term
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