Cardiovascular Adverse Outcomes as Challenges on Glycemic Variability Among Patients with Type 2 Diabetes on Intensive Insulin Therapy: The Role of Medical Nutrition Therapy with Automatic Snacking

The glycemic variability (GV) is the fluctuation of the blood glucose (BG) in relation to the daily mean BG or mean glycosylated hemoglobin (HbA1c). BG oscillations can be influenced by the type of food and timing of intake, activity, psychological condition (fear of hypoglycemia), and systemic hormonal cross-talking between insulin and glucagon. Pharmacologically, these BG oscillations can be affected by the regulators of insulin secretion like sulfonylurea and insulin. The increase in GV with very high and very low BG excursions has been associated with the development of macrovascular and microvascular complications among type 2 diabetes mellitus (DM) patients. Increased mortality has been demonstrated in the past among elderly patients on intensive insulin therapy due to severe hypoglycemia. Prompt intake of glucose has obviously compromised glycemic control and worsens the GV. Automatic snacking (AS) as a part of medical nutrition therapy (MNT) is the provision of snacks 2 h after meals which are taken even in the absence of hunger. This review will showcase our published papers among patients with type 2 DM where AS was instituted to obtain long-term glycemic control and prevent the occurrence of fatal postprandial hypoglycemia. Although, further research is needed, AS is a promising dietary management to address GV in type 2 DM patients on intensive insulin therapy.

The effect of short-term intensive insulin therapy in newly-diagnosed Type-2 diabetic patients

Objectives: We aimed to determine the effect of short-term intensive insulin therapy (SIIT) on long-term glycemic control in newly-diagnosed Type-2 diabetes mellitus (nT2DM) patients. Methods: In this retrospectively study conducted at Sakarya University Medical Faculty Training and Research Hospital Outpatient Clinic between 2016 and 2019, 65 nT2DM patients were enrolled soon after their SIIT was initiated and were followed for at least a year. Intensive insulin treatment was discontinued after three or 12 months in a total of 65 (23–73-year-old) patients who had been newly diagnosed with T2DM. Intensive insulin therapy was discontinued when glycemic control and the target Glycated Hemoglobin (HbA1c) level had been attained, after which oral anti-diabetic drug (OAD), long-term insulin, and diet therapies were pursued. Results: There was a significant decrease in mean HbA1c from 11.25±1.96% to 6.67±1.07%. Fasting plasma glucose (FPG) was found to be an independent predictor of whether intensive insulin therapy could be discontinued after three months in a model that included FPG, HbA1c, and body mass index measured at baseline. Patients with FPG >13.8 mmol/L were 7.6 times more likely to require intensive insulin therapy beyond three months. There were significant decreases in HbA1c and low-density lipoprotein-cholesterol concentration, but no change in C-peptide between baseline and 3 months of therapy. Conclusion: These results demonstrate that in nT2DM patients, intensive insulin therapy could be effective on long-term glycemic control and high FPG prior to three months of SIIT may predict poor long-term glycemic control. doi: https://doi.org/10.12669/pjms.37.7.4013 How to cite this:Karacaer C, Demirci T, Cengiz H, Varim C, Tamer A. The effect of short-term intensive insulin therapy in newly-diagnosed Type-2 diabetic patients. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4013 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.