Effect of short-term intensive insulin therapy on the incretin response in early type 2 diabetes

Decreased circulating dipeptidyl peptidase-4 activity after short-term intensive insulin therapy predicts clinical outcomes in patients with newly diagnosed type 2 diabetes

Background

This study aims to investigate the changes in circulating dipeptidyl peptidase-4 (DPP-4) activity following short-term intensive insulin therapy (SIIT) in newly diagnosed type 2 diabetes (T2D) patients and to assess its potential in predicting long-term remission.

Methods

Ninety-five patients underwent SIIT for 2-3 weeks to attain and sustain near-normal glycemia. Insulin was then discontinued, and patients were followed for a year to evaluate glycemic outcomes. Biochemical tests, serum DPP-4 activity, and mixed meal tolerance tests were conducted at baseline, post-SIIT, and the 3-month follow-up.

Results

DPP-4 activity decreased from 44.08 ± 9.58 to 40.53 ± 8.83 nmol/min/mL after SIIT (P<0.001). After three months post-SIIT, DPP-4 activity remained stable in the remission group (39.63 ± 8.53 nmol/L) but increased in the non-remission group (42.34 ± 6.64 nmol/L). This resulted in a more pronounced decrease in DPP-4 activity from baseline in the remission group (-3.39 ± 8.90 vs. -1.10 ± 8.95, P = 0.035). Logistic regression analyses showed that patients with greater DPP-4 activity reduction had a higher likelihood of 1-year remission (70% vs. 51.1%, OR: 7.939 [1.829, 34.467], P = 0.006 in the fully adjusted model). A non-linear relationship between △DPP-4 and 1-year remission rate was observed, with a clear threshold and saturation effect.

Conclusion

Circulating DPP-4 activity significantly decreases after SIIT. The change in circulating DPP-4 activity during the 3-month post-treatment phase has the potential to predict long-term remission.

Simplified, Low-Cost Method on Glucose Tolerance Testing in High-Risk Group of Diabetes, Explored by Simulation of Diagnosis

Objective: Explore the distribution of basic characteristics of high-risk groups of diabetes; verify the practical significance and diagnostic value of the “three-point method”; layered analysis of glycated hemoglobin and glycated serum albumin, and study its value and significance in the diagnosis of diabetes mellitus, Type II and pre-diabetes mellitus, Type II.Methods: 1304 high-risk individuals with T2D in Shanghai, 529 males and 841 females with an average of (50.5 ± 15.2) years old, were examined by oral glucose tolerance test (OGTT), HbA1c and GA were determined. Process the data by Python and GraphPad; judge the diagnostic value of HbA1C, GA by ROC.Results: (1) The numbers of DM, NGT, HOG, IFG, Mild–IGT and Mid–IGT in the objects were 647, 141, 70, 4, 208 and 234 respectively. In the 43-49 age group with a higher incidence, the proportion of selected high-risk groups is low. (2) The sensitivity and specificity about “three-point method” used to determine NGT is 100% and 90.11%; to determine IGR is 75.11% and 97.32%; to determine HOG is 97.14% and 100%; to determine DM is 94.67% and 100%. (3) According to ROC judgment, it is found that these 2 did not have the function of separate diagnoses, the optimal critical point of HbA1C related to DM status is 5.95%, (P<.01); HbA1C related to IGR status is 5.75% (P<.01); of GA related to DM status is 15.25% (P<.01); GA related to IGR status is 14.95% (P<.01).

Should the last be first? Questions and dilemmas regarding early short-term insulin treatment in Type 2 Diabetes Mellitus

INTRODUCTION

Early short-term insulin treatment (STIT), defined as insulin administration shortly after diabetes diagnosis for only a brief period of time, is an alternative concept, aiming to entirely revise the perspective of type 2 diabetes (T2DM) management.

AREAS COVERED

The present review intends to summarize what is already known regarding early STIT in T2DM and highlight questions and dilemmas from the clinician's point of view, with a discourse on future research agenda.

EXPERT OPINION

STIT has the potential to modify the natural history of T2DM, resulting in improved drug-free remission rates by favorably affecting the underlying pathophysiology of the disease. Existing data in the field manifest significant weaknesses, mainly being the small number of trials and patients included, the lack of control groups in most studies and the wide heterogeneity between study designs and explored outcomes, which limit definitive conclusions. Therefore, before such a therapeutic strategy is incorporated into daily practice, important issues require further clarification by future trials. These issues include the optimal time point for the intervention, the ideal insulin type, the identification of patients being most likely to benefit, the STIT effects on cardiovascular and other clinical outcomes and the cost-effectiveness evaluation of this therapeutic strategy.

ABBREVIATIONS

T2DM: Type 2 Diabetes Mellitus; HbA_1C: Hemoglobin A_1c; OHA: Oral Hypoglycemic Agents; STIT: Short-term Insulin Treatment; CSII: Continuous Subcutaneous Insulin Infusion; MDI: Multiple Daily Injections; PPG: Postprandial Plasma Glucose; FPG: Fasting Plasma Glucose; HOMA-b: Homeostasis Model Assessment of beta-cell function; TDD: Total Daily Insulin Dose; DI: Disposition Index; HOMA-IR: Homeostasis Model Assessment of Insulin Resistance; ROS: Reactive Oxygen Species; TNF: Tumor Necrosis Factor; GLP-1: Glucagon-like peptide-1; GIP: Glucose-dependent Insulinotropic Polypeptide; BMI: Body Mass Index; CV: Cardiovascular; DR: Diabetic Retinopathy; SU: Sulfonylurea; IGI: Insulinogenic Index.