Affiliation:
1. Leadership Sinai Centre for Diabetes Mount Sinai Hospital Toronto Ontario Canada
2. Lunenfeld‐Tanenbaum Research Institute, Mount Sinai Hospital Toronto Ontario Canada
3. Division of Endocrinology University of Toronto Toronto Ontario Canada
Abstract
AbstractAimTo identify baseline determinants of diabetes remission in response to short‐term insulin‐based therapy.MethodsIn this study, adult patients with type 2 diabetes (T2D) of less than 7 years duration were randomized to 8 weeks of treatment with (a) insulin glargine, (b) glargine + thrice‐daily lispro, or (c) glargine + twice‐daily exenatide, followed by 12 weeks of washout that enabled assessment of remission (defined as HbA1c < 6.5% after ≥ 3 months without glucose‐lowering therapy). At baseline, 8 weeks and washout, beta‐cell function was assessed with four measures: Insulin Secretion‐Sensitivity Index‐2 (ISSI‐2), insulinogenic index/Homeostatic Model Assessment for Insulin Resistance (HOMA‐IR), ΔC‐peptide0‐120/Δglucose0‐120 × Matsuda and Δinsulin secretion rate (ISR)0‐120/Δgluc0‐120 × Matsuda.ResultsDiabetes remission was achieved in 31 of 90 participants (34.4%). Compared with their peers, those who went on to remission had lower HbA1c (P < .001) and better beta‐cell function at baseline (all four measures P ≤ .01). The non‐remission and remission groups did not otherwise differ in baseline insulin sensitivity/resistance (Matsuda, HOMA‐IR), body mass index, duration of diabetes, pretrial diabetes medications or allocated insulin‐based therapy during the trial. On logistic regression analyses, each baseline measure of beta‐cell function emerged as a significant predictor of remission (log ISSI‐2: adjusted OR 4.41 [95% CI: 1.71‐11.34]; log insulinogenic index/HOMA‐IR: 2.21 [1.26‐3.89]; log ΔC‐peptide0‐120/Δglucose0‐120 × Matsuda: 1.62 [1.00‐2.64]; log ΔISR0‐120/Δgluc0‐120 × Matsuda: 1.87 [1.09‐3.23]). Similarly, higher baseline ISSI‐2 tertile predicted longer time to glycaemic relapse after cessation of the insulin‐based therapy (log‐rank P = .029).ConclusionBeta‐cell function is the dominant baseline pathophysiological determinant of the likelihood of achieving remission of diabetes in response to short‐term insulin‐based therapy.
Funder
Banting and Best Diabetes Centre, University of Toronto
Canadian Institutes of Health Research
Heart and Stroke Foundation of Canada
Subject
Endocrinology,Endocrinology, Diabetes and Metabolism,Internal Medicine
Cited by
2 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献