Hui Wang1, Jian Kuang2, Mingtong Xu3, Zhengnan Gao4, Qifu Li5, Shiping Liu6, Fan Zhang7, Yerong Yu8, Zhen Liang9, Weigang Zhao10, Gangyi Yang11, Ling Li12, Yang Wang13, Guangwei Li1,14. 1. Department of Endocrinology, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing China. 2. Department of Endocrinology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, China. 3. Department of Endocrinology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China. 4. Department of Endocrinology, Dalian Municipal Central Hospital, Liaoning, China. 5. Department of Endocrinology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China. 6. Department of Endocrinology, Second Xiangya Hospital of Central South University, Changsha, China. 7. Department of Endocrinology, Peking University Shenzhen Hospital, Guangdong, China. 8. Department of Endocrinology, West China Hospital, Sichuan University, Sichuan, China. 9. Department of Endocrinology, Shenzhen Second People's Hospital, Guangdong, China. 10. Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China. 11. Department of Endocrinology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China. 12. Department of Endocrinology, Shengjing Hospital of China Medical University, Liaoning, China. 13. Statistics Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China. 14. Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China.
Abstract
CONTEXT: Although several studies suggest that improved β-cell function is a key determinant of glycemic remission in type 2 diabetes, other predictors remain unclear. OBJECTIVE: The aim of this clamp-based study was to identify predictors of 2-year glycemic remission after short-term intensive insulin treatment. DESIGN: A 2-year follow-up was planned in 124 drug-naive patients with type 2 diabetes who received continuous subcutaneous insulin infusion (CSII) for 2 weeks. Euglycemic-hyperinsulinemic clamps and IV glucose tolerance tests were performed to assess the insulin sensitivity [glucose infusion rate (GIR)] and acute insulin response (AIR) before and after CSII. RESULTS: First-phase insulin secretion was restored, and the GIR was significantly improved (P < 0.0001) after the 2-week CSII. Glycemic remission rates were 47.6% and 30.7% after 12 and 24 months of follow-up, respectively. Cox analysis revealed that a higher post-CSII glucose level [hazard ratio (HR), 1.38; 95% CI, 1.15 to 1.66; P = 0.0005] and older age at diabetes diagnosis (HR, 1.34; 95% CI, 1.05 to 1.72; P = 0.02) accounted for an increased risk of hyperglycemic relapse. A 1 SD increase in the AIR (HR, 0.75; 95% CI, 0.57 to 0.99; P = 0.04), GIR (HR, 0.67; 95% CI, 0.48 to 0.93; P = 0.016) after CSII, and baseline GIR (HR, 0.71; 95% CI, 0.51 to 0.99; P = 0.047) was inversely associated with this risk. CONCLUSIONS: Younger age at diabetes diagnosis, higher baseline insulin sensitivity, and lower glucose levels after insulin treatment significantly favored a 2-year glycemic remission. This long-term remission was attributed to both improved insulin sensitivity and enhanced β-cell function after short-term intensive insulin treatment.
CONTEXT: Although several studies suggest that improved β-cell function is a key determinant of glycemic remission in type 2 diabetes, other predictors remain unclear. OBJECTIVE: The aim of this clamp-based study was to identify predictors of 2-year glycemic remission after short-term intensive insulin treatment. DESIGN: A 2-year follow-up was planned in 124 drug-naive patients with type 2 diabetes who received continuous subcutaneous insulin infusion (CSII) for 2 weeks. Euglycemic-hyperinsulinemic clamps and IV glucose tolerance tests were performed to assess the insulin sensitivity [glucose infusion rate (GIR)] and acute insulin response (AIR) before and after CSII. RESULTS: First-phase insulin secretion was restored, and the GIR was significantly improved (P < 0.0001) after the 2-week CSII. Glycemic remission rates were 47.6% and 30.7% after 12 and 24 months of follow-up, respectively. Cox analysis revealed that a higher post-CSII glucose level [hazard ratio (HR), 1.38; 95% CI, 1.15 to 1.66; P = 0.0005] and older age at diabetes diagnosis (HR, 1.34; 95% CI, 1.05 to 1.72; P = 0.02) accounted for an increased risk of hyperglycemic relapse. A 1 SD increase in the AIR (HR, 0.75; 95% CI, 0.57 to 0.99; P = 0.04), GIR (HR, 0.67; 95% CI, 0.48 to 0.93; P = 0.016) after CSII, and baseline GIR (HR, 0.71; 95% CI, 0.51 to 0.99; P = 0.047) was inversely associated with this risk. CONCLUSIONS: Younger age at diabetes diagnosis, higher baseline insulin sensitivity, and lower glucose levels after insulin treatment significantly favored a 2-year glycemic remission. This long-term remission was attributed to both improved insulin sensitivity and enhanced β-cell function after short-term intensive insulin treatment.
Authors: Lina Shibib; Mo Al-Qaisi; Ahmed Ahmed; Alexander D Miras; David Nott; Marc Pelling; Stephen E Greenwald; Nicola Guess Journal: Vasc Health Risk Manag Date: 2022-06-14