Carlo B Giorda1, Giuseppina T Russo2, Stefania Cercone3, Salvatore De Cosmo4, Antonio Nicolucci5, Domenico Cucinotta2. 1. Metabolism and Diabetes Unit ASL TO5, Regione Piemonte, Via De Maria, 10023, Chieri (TO), Italy. giordaca@tin.it. 2. Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. 3. MSD, Rome, Italy. 4. Unit of Internal Medicine, Department of Medical Sciences, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy. 5. Center for Outcomes Research and Clinical Epidemiology (CORE), Pescara, Italy.
Abstract
AIMS: Type 2 diabetes is associated with progressive deterioration of beta cell function and loss of glycemic control, with increased morbidity and mortality from microvascular and macrovascular complications. Factors predictive of beta cell decline are needed. METHODS: We have conducted a prospective evaluation of baseline predictors of beta cell dysfunction and insulin initiation in a cohort of outpatients with type 2 diabetes receiving stable treatment with oral hypoglycemic agents or dietary intervention, over a 4-year follow-up period. RESULTS: Of 507 patients enrolled, 56 (10.8 %) experienced the study endpoint of initiation of insulin therapy. Univariate and multivariate Cox proportional hazard regression analyses revealed that the likelihood of initiating insulin therapy during follow-up increased with longer diabetes duration and with higher baseline values for hemoglobin A1c, fasting plasma glucose, triglycerides, proinsulin, interleukin-6, Homeostatic Model Assessment-IR and lower values for Homeostatic Model Assessment-B. The likelihood of initiating insulin therapy increased by 46 % for each 1 % increase (10.9 mmol/mol) in baseline hemoglobin A1c and by 6 % for each unit increase (1 ng/l) in baseline IL-6 level. The risk was fourfold higher in the lowest versus highest Homeostatic Model Assessment-B quartile. Treatment with metformin plus a secretagogue increased the risk by fourfold. CONCLUSIONS: Our results show that commonly measured parameters may predict treatment failure in type 2 diabetes and suggest that early treatment with metformin plus secretagogues may foretell this failure.
AIMS: Type 2 diabetes is associated with progressive deterioration of beta cell function and loss of glycemic control, with increased morbidity and mortality from microvascular and macrovascular complications. Factors predictive of beta cell decline are needed. METHODS: We have conducted a prospective evaluation of baseline predictors of beta cell dysfunction and insulin initiation in a cohort of outpatients with type 2 diabetes receiving stable treatment with oral hypoglycemic agents or dietary intervention, over a 4-year follow-up period. RESULTS: Of 507 patients enrolled, 56 (10.8 %) experienced the study endpoint of initiation of insulin therapy. Univariate and multivariate Cox proportional hazard regression analyses revealed that the likelihood of initiating insulin therapy during follow-up increased with longer diabetes duration and with higher baseline values for hemoglobin A1c, fasting plasma glucose, triglycerides, proinsulin, interleukin-6, Homeostatic Model Assessment-IR and lower values for Homeostatic Model Assessment-B. The likelihood of initiating insulin therapy increased by 46 % for each 1 % increase (10.9 mmol/mol) in baseline hemoglobin A1c and by 6 % for each unit increase (1 ng/l) in baseline IL-6 level. The risk was fourfold higher in the lowest versus highest Homeostatic Model Assessment-B quartile. Treatment with metformin plus a secretagogue increased the risk by fourfold. CONCLUSIONS: Our results show that commonly measured parameters may predict treatment failure in type 2 diabetes and suggest that early treatment with metformin plus secretagogues may foretell this failure.
Entities:
Keywords:
Beta cell function; Secondary failure; Type 2 diabetes
Authors: Anand Thakarakkattil Narayanan Nair; Louise A Donnelly; Adem Y Dawed; Sushrima Gan; Ranjit M Anjana; Mohan Viswanathan; Colin N A Palmer; Ewan R Pearson Journal: Endocrinol Diabetes Metab Date: 2020-01-07
Authors: Sergiy V Korol; Zhe Jin; Yang Jin; Amol K Bhandage; Anders Tengholm; Nikhil R Gandasi; Sebastian Barg; Daniel Espes; Per-Ola Carlsson; Derek Laver; Bryndis Birnir Journal: EBioMedicine Date: 2018-03-22 Impact factor: 8.143