Younger, more insulin-sensitive T2DM patients benefit most from intensive insulin

By Reuters staff

NEW YORK (Reuters Health) - 23/1/2019

Patients with newly diagnosed type 2 diabetes can experience long-term glycemic remission with intensive insulin treatment - but this effect is more likely in younger patients and those with lower post-treatment glucose levels, according to new findings in the Journal of Clinical Endocrinology and Metabolism.

"This long-term remission was attributed to both improved insulin sensitivity and enhanced beta-cell function after short-term intensive insulin treatment," Dr. Hui Wang of Fuwai Hospital and Chinese Academy of Medical Sciences and colleagues write in their January 9 report.

The researchers performed a euglycemic-hyperinsulinemic clamp study in 124 drug-naive T2D patients who underwent short-term continuous subcutaneous insulin infusion (CSII) for two weeks.

At one year, 47.6% were in glycemic remission, and 30.7% remained in remission two years later.

The risk of hyperglycemic relapse was increased in patients with higher glucose levels after CSII (hazard ratio 1.38) and those who were older when diagnosed with T2D, Wang and colleagues found. A one standard deviation (SD) increase in acute insulin response (AIR) was associated with reduced relapse risk (HR 0.75). Similar increases in baseline and post-CSII glucose infusion rate (GIR) were also associated with reduced risk (HR 0.71 and 0.67).

"It should be noted that in newly diagnosed type 2 diabetic patients, even those with an extremely high FPG, the impaired sensitivity and beta cell function can be largely reversed by the early implementation of short-term intensive insulin treatment," they write. "These findings suggest a great potential for the restoration of insulin secretion function and insulin sensitivity in the early stage of type 2 diabetes."

SOURCE: J Clin Endocrinol Metab 2019.

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