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The Five-years Efficacy After Short-term Insulin Intensive Treatment in Newly Diagnosed Type2Diabetes

Author: YuDaHong
Tutor: BaiRan
School: Dalian Medical University
Course: Internal Medicine
Keywords: Diabetes mellitus type2 Newly diagnosedInsulin intensive therapy β-cell function Insulin sensitivity
CLC: R587.1
Type: Master's thesis
Year: 2012
Downloads: 6
Quote: 0
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Abstract


Background: type2diabetes mellitus (T2DM) is considered as the result ofcombined effects of β-cell function inadequate and insulin resistance (IR),among them,the β-cell function inadequate is the necessary condition of T2DM.The study found thatthe β-cell function of newly diagnosed type2diabetic patients decreased to50%compared with those of healthy subjects. Moreover, β-cell function inadequate duringthe early stage could be controlled, or even reversible. Therefore, the hypoglycemictreatment for newly diagnosed T2DM should be different from those with long duration.In this study, the patients with newly diagnosed T2DM underwent short-term intensivehypoglycemic intervention either with continuous subcutaneous insulin infusion (CSII)or the multiple daily insulin injection (MDI). We observed the long-term effect ofmetabolic memory (5year later), safety, the effects on β cell function, and insulinsensitivity to provide a more favorable evidence for insulin short-term intensive therapyin newly diagnosed T2DM.Methods: According to the diagnostic and classification criteria recommended bythe World Health Organization (WHO) in1999, fifty-eight newly diagnosed T2DMpatients in our hospital from March2007to June2007were selected in our study,withfasting plasma glucose (FPG)≥11.1mmol/L, and/or glycosylated hemoglobin(HbA1c)≥10%,have not received any OHAs before, no chronic diabeticcomplications, no severe acute diabetic complications and no severe complications inheart, liver, kidney. On the first day of admission, height and weight were measured tocalculate body mass index (BMI), FPG, HbA1c, and postprandial2hour blood glucose(2hPBG) after three meals were determined. When blood glucose decreased stably(insulin intensive therapy for about2weeks), we measured FPG,2hPBG, fasting C peptide (FCP) and OGTT2-hour C peptide (2hCP). We used homeostasis modelassessment formula to calculate HOMA-IR (homeostasis model assessment-insulinresistance) and HOMA-β (homeostasis model assessment-pancreatic β cell). Afteradmission, the patients performed short-term intensive hypoglycemic intervention eitherwith continuous subcutaneous insulin infusion (CSII group) or the multiple daily insulininjection (MDI group). The target was FBG<7mmol/L and2hPBG<10mmol/L. Theperiod of targeting and insulin dosage were recorded. After discharge, according toβ-cell function and insulin dosage,36patients followed by subcutaneous insulininjection (Ins),20patients controlled by oral hypoglycemic agents (OHA), and the rest2ones interfered only by lifestyle (lifestyle), All of them were continued their treatmentfor three months, and then the above indicators were controlled their glycaemiaout-patients. All the characters mentioned above were re-checked after5year and theoccurrence of the chronic complications and the adjustments of intervention were alsorecorded during this period.Results:1. The characters at the baseline showed no significant difference between CSIIgroup and MDI group, which including gender, age, BMI,SBP(systolic blood pressure),DBP(diastolic blood pressure), FPG, HbA1c, TC(cholesterol total), TG(glycerintrilaurate), LDL-C(low density lipoprotein cholesterol), HDL-C(high density lipoproteincholesterol), FCP,2hCP, Homa-IR, and Homa-β (P>0.05). After the insulin intensivetreatment for2weeks, the FPG of both group decreased obviously (P>0.05), moreover,the dosage of insulin and the time of reaching-goal were significant difference between2groups (P <0.05).2.Five-years outcome showed that FPG, Homa-IR and FCP is statisticallysignificant in CSII group (P <0.05),and only FCP is statistically significant in MDIgroup(P <0.05). No statistical differences were found between the two groups (P>0.05).3., All of the patients were divided into2teams after five years following up,according to the value of HbA1c, the reaching-goal team(HbA1c <7%) and theun-reaching-goal team (HbA1c≥7%). FPG, FCP,2hCP, and the Homa-β observed thesignificant differences between two team (P<0.05). Age, follow-up frequency, andself-management were the relative independent factors of compliance.4. Till the five years of follow-up,15cases (25.8%) re-used insulin,36cases(62.1%) changed to OHA and the rest of the7cases (12.1%) only interfered by lifestyle among58cases of diabetes patients.5. All patients after5years one patient suffered from cerebral infarction, and sevenindividuals suffered from microvascular diseases, The HbA1c level of patients withchronic complications were lower than that of patients without chronic complications(P<0.05).Conclusion:1. Both of the CSII and MDI intensive treatments of short-term could control theblood glucose effectively.However, the lower insulin dosage, shorter time achieved thetarget, and less incidence of hypoglycemia were observed in CSII group compared toMDI group.2. Short-term insulin intensive therapy could restore the function of damaged isletβ-cell of newly diagnosed type2diabetic patients. Some patients even achievedlong-term complete clinical remission without using any medicine. The continuinghypoglycemic effect after five years might due to the effect of “metabolic memory”, andthe insulin sensitivity was enhanced at the same time.3. Age, frequency of follow-up, and self-management were the independent factorsof glucose compliance. Especially, the regular outpatient follow-up could control theblood glucose very well and reduce the occurrence of acute and chronic diabeticcomplications.

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CLC: > Medicine, health > Internal Medicine > Endocrine diseases and metabolic diseases > Islet disease > Diabetes
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