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Chen J, Dai P, Ke W, Wan X, Liu J, Xu L, Xiao H, Li Y, Liu L. Decreased circulating dipeptidyl peptidase-4 activity after short-term intensive insulin therapy predicts clinical outcomes in patients with newly diagnosed type 2 diabetes. Front Endocrinol (Lausanne) 2024; 15:1352002. [PMID: 38476668 PMCID: PMC10929261 DOI: 10.3389/fendo.2024.1352002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/13/2024] [Indexed: 03/14/2024] Open
Abstract
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.
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Affiliation(s)
| | | | | | | | | | | | | | - Yanbing Li
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Liehua Liu
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
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Zhang X, Yan D, Du T, Zhao Y, Zhang J, Zhang T, Lin M, Li Y, Li W. Efficacy and safety of basal-bolus insulin at 1:1.5 ratio compared to 1:1 ratio using a weight-based initiation and titration (WIT2) algorithm in hospitalized patients with type 2 Diabetes: a multicenter, randomized, clinical study. Diabetol Metab Syndr 2023; 15:243. [PMID: 38008775 PMCID: PMC10680246 DOI: 10.1186/s13098-023-01193-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/16/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Most studies initiated basal-bolus insulin in a ratio of 1:1 and titrated based on glucose. This study aimed to investigate the effectiveness and safety of a weight-based and ratio of 1:1.5 basal-bolus insulin using an algorithm for both initiation and titration in hospitalized patients with type 2 diabetes (T2D). METHODS Hospitalized patients with T2D were randomly assigned to two groups in equal numbers to receive 1:1.5 and 1:1 ratios of basal-bolus insulin using a weight-based algorithm for both initiation and titration. The primary outcome was the time taken to reach the fasting blood glucose (FBG) target and 2-h postprandial blood glucose (2hBG) targets after three meals. The secondary outcome included insulin dosage to achieve glycemic control and the incidence of hypoglycemia during hospitalization. RESULTS 250 patients were screened between October 2021 and June 2022, 220 were randomly grouped, and 182 completed the trial (89 in the 1:1.5 and 93 in the 1:1 groups). The time taken to reach FBG targets was comparable between the two groups (3.4 ± 1.7 vs. 3.0 ± 1.3 days, p = 0.137) within about 3 days. The 2hBG after three meals was shorter in the 1:1.5 group than in the 1:1group (2.9 ± 1.5 vs. 3.4 ± 1.4 days, p = 0.015 for breakfast, 3.0 ± 1.6 vs. 3.6 ± 1.4 days, p = 0.005 for lunch, and 3.1 ± 2.1 vs. 4.0 ± 1.5 days, p = 0.002 for dinner). No significant difference in insulin dosages was found between the two groups at the end of the study. The incidence of hypoglycemia was similar in both groups. CONCLUSIONS We demonstrated that fixed dose-ratio basal-bolus insulin at 1:1.5 calculated using a weight-based initiation and titration algorithm was simple, as effective, and safe as ratio at 1:1 in managing T2D in hospitalized patients. Trial Registration ChiCTR 2,100,050,963. Date of registration: September 8, 2021.
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Affiliation(s)
- Xiaodan Zhang
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dewen Yan
- Department of Endocrinology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Tao Du
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yunjuan Zhao
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiangong Zhang
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tong Zhang
- Department of Endocrinology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Mingrun Lin
- Department of Endocrinology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yanli Li
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Wangen Li
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Hao S, Umpierrez GE, Daley T, Vellanki P. Intervention with Therapeutic Agents, Understanding the Path to Remission in Type 2 Diabetes: Part 1. Endocrinol Metab Clin North Am 2023; 52:27-38. [PMID: 36754495 DOI: 10.1016/j.ecl.2022.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Type 2 diabetes is characterized by progressive decline in pancreatic β-cell function. Studies in adult subjects with newly diagnosed type 2 diabetes have reported that intensive insulin therapy followed by various antihyperglycemic medications can delay β-cell decline. However, this improvement is lost after cessation of therapy. In contrast, youth with type 2 diabetes experience a more rapid loss in β-cell function compared with adults and have loss of β-cell function despite being on insulin and other antihyperglycemic medications. In part one of this two-part review, we discuss studies aiming to achieve diabetes remission with insulin and oral antidiabetic medications.
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Affiliation(s)
- Shuai Hao
- Division of Pediatric Endocrinology, Children's Healthcare of Atlanta, Emory University School of Medicine, 1400 Tullie Road Northeast, Atlanta, GA 30329, USA
| | - Guillermo E Umpierrez
- Division of Endocrinology, Metabolism & Lipids, Emory University School of Medicine, 69 Jesse Hill Jr Drive Southeast, Glenn Building, Room 205, Suite 200, Atlanta, GA 30303, USA
| | - Tanicia Daley
- Division of Pediatric Endocrinology, Children's Healthcare of Atlanta, Emory University School of Medicine, 1400 Tullie Road Northeast, Atlanta, GA 30329, USA
| | - Priyathama Vellanki
- Division of Endocrinology, Metabolism & Lipids, Emory University School of Medicine, 69 Jesse Hill Jr Drive Southeast, Glenn Building, Room 205, Suite 200, Atlanta, GA 30303, USA.
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Basit A, Fawwad A, Abdeali M. Diet and insulin dose as mediators of insulin-associated weight gain among people in Pakistan with type 2 diabetes. JOURNAL OF DIABETOLOGY 2022. [DOI: 10.4103/jod.jod_45_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Freckmann G, Buck S, Waldenmaier D, Kulzer B, Schnell O, Gelchsheimer U, Ziegler R, Heinemann L. Insulin Pump Therapy for Patients With Type 2 Diabetes Mellitus: Evidence, Current Barriers, and New Technologies. J Diabetes Sci Technol 2021; 15:901-915. [PMID: 32476471 PMCID: PMC8258526 DOI: 10.1177/1932296820928100] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
An increasing number of patients with type 2 diabetes mellitus (T2DM) use insulin pumps. The first insulin pumps especially designed for patients with T2DM have recently become available. However, national guidelines do not primarily recommend the use of continuous subcutaneous insulin infusion (CSII) for this patient group. The effectiveness of CSII in T2DM has not yet been convincingly demonstrated, despite some positive evidence. An overview and an assessment of various studies to date will be given. T2DM is a heterogeneous disease with a substantial phenotypic variability; therefore, it is difficult to provide general conclusions about the effectiveness of CSII in T2DM therapy. The pump types, characteristics, and associated barriers may play a relevant role for therapy outcome. Most advanced functions like various bolus dosages offered by conventional insulin pumps are not needed for T2DM treatment and complicate the device handling for this subject group. Additionally, new technologies like increased connectivity, advanced software features, and interoperability are currently becoming available representing further barriers. The implementation of this technological progress might be a benefit for pumps for T2DM as well. However, these have not been sufficiently examined either and increased security challenges due to integrated peripheral components should not be neglected in terms of a sound cybersecurity. Pump features and handling for patients with T2DM should be as easy as possible, indicating a need for insulin pumps specially designed for patients with T2DM. However, it has to be investigated if pumps designed for T2DM are more effective than other intensified insulin regimens.
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Affiliation(s)
- Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Sina Buck
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
- Sina Buck, MSc, Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Lise-Meitner-Straße 8/2, Ulm 89081, Germany.
| | - Delia Waldenmaier
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Bernhard Kulzer
- Forschungsinstitut Diabetes Akademie Bad Mergentheim, Germany
| | - Oliver Schnell
- Forschergruppe Diabetes e.V., Helmholtz Zentrum, Munich, Germany
| | | | - Ralph Ziegler
- Diabetes Clinic for Children and Adolescents, Münster, Germany
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Zhang X, Zhang T, Xiang G, Wang W, Li Y, Du T, Zhao Y, Mosha SS, Li W. Comparison of weight-based insulin titration (WIT) and glucose-based insulin titration using basal-bolus algorithm in hospitalized patients with type 2 diabetes: a multicenter, randomized, clinical study. BMJ Open Diabetes Res Care 2020; 8:8/1/e001261. [PMID: 32933950 PMCID: PMC7493103 DOI: 10.1136/bmjdrc-2020-001261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/26/2020] [Accepted: 07/30/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Subcutaneous administration of insulin is the preferred method for achieving glucose control in non-critically ill patients with diabetes. Glucose-based titration protocols were widely applied in clinical practice. However, most of these algorithms are experience-based and there is considerable variability and complexity. This study aimed to compare the effectiveness and safety of a weight-based insulin titration algorithm versus glucose-based algorithm in hospitalized patients with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS This randomized clinical trial was carried out at four centers in the South, Central and North China. Inpatients with T2DM were randomly assigned (1:1) to receive weight-based and glucose-based insulin titration algorithms. The primary outcome was the length of time for reaching blood glucose (BG) targets (fasting BG (FBG) and 2-hour postprandial BG (2hBG) after three meals). The secondary outcome included insulin dose for achieving glycemic control and the incidence of hypoglycemia during hospitalization. RESULTS Between January 2016 and June 2019, 780 patients were screened, and 575 completed the trial (283 in the weight-based group and 292 in the glucose-based group). The lengths of time for reaching BG targets at four time points were comparable between two groups. FBG reached targets within 3 days and 2hBG after three meals within 4 days. There is no significant difference in insulin doses between two groups at the end of the study. The total daily dosage was about 1 unit/kg/day, and the ratio of basal-to-bolus was about 2:3 in both groups. The incidence of hypoglycemia was similar in both groups, and severe hypoglycemia was not detected in either of the groups. CONCLUSIONS Weight-based insulin titration algorithm is equally effective and safe in hospitalized patients with T2DM compared with glucose-based algorithm. TRIAL REGISTRATION NUMBER NCT03220919.
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Affiliation(s)
- Xiaodan Zhang
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tong Zhang
- Department of Endocrinology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Guangda Xiang
- Department of Endocrinology, Wuhan General Hospital of Chinese People's Liberation Army, Wuhan, China
| | - Wenbo Wang
- Department of Endocrinology, Peking University Shougang Hospital, Beijing, China
| | - Yanli Li
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tao Du
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yunjuan Zhao
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Singla Sethiel Mosha
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wangen Li
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Koufakis T, Karras SN, Zebekakis P, Ajjan R, Kotsa K. Should the last be first? Questions and dilemmas regarding early short-term insulin treatment in Type 2 Diabetes Mellitus. Expert Opin Biol Ther 2018; 18:1113-1121. [PMID: 30244600 DOI: 10.1080/14712598.2018.1526278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
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; HbA1C: Hemoglobin A1c; 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.
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Affiliation(s)
- Theocharis Koufakis
- a Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki , AHEPA University Hospital , Thessaloniki , Greece
| | - Spyridon N Karras
- a Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki , AHEPA University Hospital , Thessaloniki , Greece
| | - Pantelis Zebekakis
- a Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki , AHEPA University Hospital , Thessaloniki , Greece
| | - Ramzi Ajjan
- b Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine , University of Leeds , Leeds , UK
| | - Kalliopi Kotsa
- a Division of Endocrinology and Metabolism and Diabetes Center, First Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki , AHEPA University Hospital , Thessaloniki , Greece
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Liu L, Liu J, Xu L, Ke W, Wan X, Li H, He X, Wang L, Cao X, Xiao H, Li Y. Lower mean blood glucose during short-term intensive insulin therapy is associated with long-term glycemic remission in patients with newly diagnosed type 2 diabetes: Evidence-based recommendations for standardization. J Diabetes Investig 2018; 9:908-916. [PMID: 29193795 PMCID: PMC6031520 DOI: 10.1111/jdi.12782] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/26/2017] [Indexed: 12/16/2022] Open
Abstract
AIMS/INTRODUCTION Optimal glycemic targets during short-term intensive insulin therapy in patients with newly diagnosed type 2 diabetes are not standardized. The present study was carried out to determine the optimal glycemic targets during therapy by analyzing the impacts of glucose levels on therapeutic outcomes. MATERIALS AND METHODS A total of 95 individuals with newly diagnosed type 2 diabetes were enrolled. Short-term intensive insulin therapy was carried out using an insulin pump to achieve and maintain glycemic targets (fasting blood glucose ≤6.0 mmol/L, 2-h postprandial blood glucose ≤7.8 mmol/L) for 14 days, with daily eight-point capillary blood glucose profiles recorded. Patients were followed up for 1 year after discharge. RESULTS In most participants, the mean blood glucose and glycemic excursion parameters during the therapy were controlled within the normal range. Mean blood glucose was independently associated with amelioration of acute insulin response (r = -0.25, P = 0.015) and 1-year remission (odds ratio 0.12, 95% confidence interval 0.034-0.426), but negatively associated with more level 1 hypoglycemia (r = -0.34, P = 0.001), although major hypoglycemia was rare. Among mean blood glucose tertiles, patients in the middle (68.7%) and lower (75.0%) tertiles had a higher 1-year remission rate compared with the upper tertile (32.3%, both P < 0.001), whereas only the middle tertile did not have increased hypoglycemia compared with the upper tertile (8.1 ± 5.4 vs 7.2 ± 3.9 events/person, P = 0.48). CONCLUSIONS Stricter glycemic control during short-term intensive insulin therapy produced more remission despite self-manageable hypoglycemia. Based on glycemic parameters in the middle mean tertile, we propose new glycemic targets that are approximately 0.4 mmol/L lower than current the targets, as long-term benefit outweighs short-term risks.
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Affiliation(s)
- Liehua Liu
- Department of EndocrinologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Juan Liu
- Department of EndocrinologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Lijuan Xu
- Department of EndocrinologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Weijian Ke
- Department of EndocrinologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Xuesi Wan
- Department of EndocrinologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Hai Li
- Department of EndocrinologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Xiaoying He
- Department of EndocrinologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Liangjiao Wang
- Department of EndocrinologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
- Present address:
Dongguan People's Hospital, Dongguan, Guangdong ProvinceChina
| | - Xiaopei Cao
- Department of EndocrinologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Haipeng Xiao
- Department of EndocrinologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Yanbing Li
- Department of EndocrinologyThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
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Hu X, Zhang L, Dong Y, Dong C, Jiang J, Gao W. Switching from biosimilar (Basalin) to originator (Lantus) insulin glargine is effective in Chinese patients with diabetes mellitus: a retrospective chart review. F1000Res 2018; 7:477. [PMID: 29862021 PMCID: PMC5941245 DOI: 10.12688/f1000research.13923.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2018] [Indexed: 02/05/2023] Open
Abstract
Background: This study investigated the effectiveness and safety of switching from Basalin® to Lantus® in Chinese patients with diabetes mellitus (DM). Methods: A retrospective chart review conducted using the electronic medical records of patients hospitalized at the Qingdao Endocrine and Diabetes Hospital from 2005 to 2016. All patients were diagnosed with DM and underwent switching of insulin from Basalin to Lantus during hospitalization. Data collected included fasting (FBG), pre- and post-prandial whole blood glucose, insulin dose, reasons for insulin switching and hypoglycemia. Four study time points were defined as: hospital admission, Basalin initiation, insulin switching (date of final dose of Basalin), and hospital discharge. Blood glucose measurements were imputed as the values recorded closest to the dates of these four time points for each patient. Results: Data from 73 patients (70 patients with type 2 diabetes, 2 with type 1, and 1 undisclosed) were analyzed. At admission, mean glycated hemoglobin (HbA1c) and FBG were 8.9% (SD=1.75) and 9.98 (3.22) mmol/L, respectively. Between Basalin initiation and insulin switch, mean FBG decreased from 9.68 mmol/L to 8.03 mmol/L (p<0.0001), over a mean 10.8 (SD=6.85) days of Basalin treatment, and reduced further to 7.30 mmol/L at discharge (p=0.0116) following a mean 6.6 (7.36) days of Lantus. The final doses of Basalin and Lantus were similar (0.23 vs. 0.24 IU/kg/day; p=0.2409). Furthermore, reductions in pre- and post-prandial blood glucose were also observed between Basalin initiation, insulin switch and hospital discharge. The incidence of confirmed hypoglycemia was low during Basalin (2 [2.4%]) and Lantus (1 [1.2%]) treatment, with no cases of severe hypoglycemia. Conclusion: In this study population, switching from Basalin to Lantus was associated with further reductions in blood glucose, although the dose of insulin glargine did not increase. Further studies are required to verify these findings and determine the reason for this phenomenon.
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Affiliation(s)
- Xia Hu
- Qingdao Endocrine and Diabetes Hospital, Qingdao, 266071, China
| | - Lei Zhang
- Qingdao Endocrine and Diabetes Hospital, Qingdao, 266071, China
| | - Yanhu Dong
- Qingdao Endocrine and Diabetes Hospital, Qingdao, 266071, China
| | - Chao Dong
- Qingdao Endocrine and Diabetes Hospital, Qingdao, 266071, China
| | - Jikang Jiang
- Qingdao Endocrine and Diabetes Hospital, Qingdao, 266071, China
| | - Weiguo Gao
- Qingdao Endocrine and Diabetes Hospital, Qingdao, 266071, China
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Liu L, Yang S, Liu J, Li H, Liu J, Cao X, Xiao H, Li Y. Fasting Plasma Glucose Indicates Reversibility of the Acute Insulin Response after Short-Term Intensive Insulin Therapy in Patients with Various Duration of Type 2 Diabetes. J Diabetes Res 2018; 2018:9423965. [PMID: 30581872 PMCID: PMC6276474 DOI: 10.1155/2018/9423965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/12/2018] [Accepted: 10/15/2018] [Indexed: 12/21/2022] Open
Abstract
Recovery of acute insulin response (AIR) is shown to be associated with long-term outcomes of patients with early type 2 diabetes treated with short-term intensive insulin therapy (SIIT). However, the complexity of measuring an AIR limits its utility in a real-world clinical setting. The aim of the study was to assess fasting indicators that may estimate recovery of the AIR after SIIT. We enrolled 62 patients with type 2 diabetes mellitus (T2DM) of varying disease duration who had poor glycemic control. Participants were treated with SIIT using insulin pumps to achieve near normoglycemia for 7 days. The AIR before and after the therapy were measured by intravenous glucose tolerance tests. After the therapy, AIR increased from -16.7 (-117.4, 52.4) pmol/L·min to 178.7 (31.8, 390.7) pmol/L·min (P < 0.001) while hyperglycemia was alleviated; this improvement was observed in all disease duration categories. AIR was almost absent when fasting plasma glucose (FPG) > 10 mmol/L, while both AIR (R = -0.53, P < 0.001) and its improvement from baseline (△AIR, R = -0.52, P < 0.001) were negatively associated with FPG after SIIT when FPG < 10 mmol/L. In multivariate analyses, FPG after SIIT and baseline fasting C peptide were independent indicators of both AIR after the therapy and ∆AIR; HDL-C after the therapy also predicted AIR after the therapy. We concluded that recovery of the AIR could be obtained in T2DM patients of varying disease duration by SIIT and it could be conveniently estimated using posttreatment fasting plasma glucose and other fasting indicators.
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Affiliation(s)
- Liehua Liu
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Siyue Yang
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
- Department of Radiology, Tuen Mun Hospital, 999077, Hong Kong
| | - Jianbin Liu
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
- Centre for Eye Research Australia, University of Melbourne, East Melbourne, VIC 3002, Australia
- Department of Medicine, Box Hill Hospital, Eastern Health, Box Hill, VIC 3128, Australia
| | - Hai Li
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Juan Liu
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Xiaopei Cao
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Haipeng Xiao
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Yanbing Li
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
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Xu L, Wang L, Huang X, Liu L, Ke W, He X, Huang Z, Liu J, Wan X, Cao X, Li Y. Baseline red blood cell distribution width predicts long-term glycemic remission in patients with type 2 diabetes. Diabetes Res Clin Pract 2017; 131:33-41. [PMID: 28672172 DOI: 10.1016/j.diabres.2017.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/12/2017] [Accepted: 06/12/2017] [Indexed: 11/24/2022]
Abstract
AIMS We explored whether red blood cell distribution width (RDW), a routinely checked item of complete blood cell counts, was an indicator of long-term euglycemia remission in patients with type 2 diabetes after short-term continuous subcutaneous insulin infusion (CSII). METHODS We analyzed the original data of patients enrolled in three randomized control trials from 2002 to 2014. CSII was administered to drug-naїve patients with newly diagnosed type 2 diabetes to achieve and maintain euglycemia for 2weeks. RESULTS A total of 185 patients were involved and 98 patients (52.97%) who achieved and maintained euglycemia for at least 12months were classified as the remission group, and the others as the non-remission group. Patients in remission group had a relatively lower value for baseline RDW (38.82±2.76vs 39.89±2.78fL, p=0.017) compared with those in non-remission group. A graded decrease of remission rate (67.50%, 55.00%, 53.66% and 30.77% for Quartile 1 to Quartile 4 respectively, P<0.05) was observed with the increasing of RDWs. The risk of hyperglycemic relapse was significantly increased for those in the highest quartile compared with the lowest (hazard ratio=2.68; 95% CI, 1.38-5.22). Those who achieved euglycemia within 7days or obtained a better fasting glucose after therapy had preferable remission rates. CONCLUSIONS Patients with lower baseline RDWs are more likely to maintain a one-year euglycemia remission after short-term CSII. A faster normalization of glucose during treatment and a lower fasting glucose after therapy are correlated with a long-term glucose control.
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Affiliation(s)
- Lijuan Xu
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, 58th of Zhongshan Er Road, Guangzhou, China
| | - Liangjiao Wang
- Department of Endocrinology, Dongguan People's Hospital, Dongguan City, Guangdong Province, China
| | - Xinwei Huang
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, 58th of Zhongshan Er Road, Guangzhou, China
| | - Liehua Liu
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, 58th of Zhongshan Er Road, Guangzhou, China
| | - Weijian Ke
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, 58th of Zhongshan Er Road, Guangzhou, China
| | - Xiaoying He
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, 58th of Zhongshan Er Road, Guangzhou, China
| | - Zhimin Huang
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, 58th of Zhongshan Er Road, Guangzhou, China
| | - Juan Liu
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, 58th of Zhongshan Er Road, Guangzhou, China
| | - Xuesi Wan
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, 58th of Zhongshan Er Road, Guangzhou, China
| | - Xiaopei Cao
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, 58th of Zhongshan Er Road, Guangzhou, China
| | - Yanbing Li
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, 58th of Zhongshan Er Road, Guangzhou, China.
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12
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Maiorino MI, Bellastella G, Esposito K, Giugliano D. Premixed insulin regimens in type 2 diabetes: pros. Endocrine 2017; 55:45-50. [PMID: 27003435 DOI: 10.1007/s12020-016-0917-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 03/04/2016] [Indexed: 01/16/2023]
Abstract
Because of the increasing prevalence of type 2 diabetes, the need to intensify treatment to manage hyperglycemia is expanding. Premixed insulin regimens were designed to maximize patient convenience and reduce the number of daily injections required by providing both rapid-acting and intermediate-acting components in one formulation. Although the basal bolus insulin regimen is considered by many as "the golden standard" in reaching goals of glycemic control, proper use of intensified insulin regimens, such as basal bolus or premixed, will result in similar HbA1c reduction, hypoglycemic events, and weight gain. At the same number of daily insulin injections (2 shots/day), the premixed regimen is associated with a significant 0.2 % HbA1c decrease, as compared with the basal plus regimen (one shot of long-acting plus one shot of short-acting insulin). The choice of insulin regimen should consider the preferences, and resources of the individual and the family for adapting treatment to the patient needs. At last, the process of insulin initiation and intensification in type 2 diabetes must be carried out in the context of patient safety, minimizing the risk of hypoglycemia, weight gain, and injection burden.
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Affiliation(s)
- Maria Ida Maiorino
- Diabetes Unit, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Giuseppe Bellastella
- Division of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Second University of Naples, Naples, Italy
| | - Katherine Esposito
- Division of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Second University of Naples, Naples, Italy
| | - Dario Giugliano
- Diabetes Unit, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy.
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13
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Landau Z, Raz I, Wainstein J, Bar-Dayan Y, Cahn A. The role of insulin pump therapy for type 2 diabetes mellitus. Diabetes Metab Res Rev 2017; 33. [PMID: 27189155 DOI: 10.1002/dmrr.2822] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 04/11/2016] [Accepted: 05/04/2016] [Indexed: 11/10/2022]
Abstract
Many patients with type 2 diabetes fail to achieve adequate glucose control despite escalation of treatment and combinations of multiple therapies including insulin. Patients with long-standing type 2 diabetes often suffer from the combination of severe insulin deficiency in addition to insulin resistance, thereby requiring high doses of insulin delivered in multiple injections to attain adequate glycemic control. Insulin-pump therapy was first introduced in the 1970s as an approach to mimic physiological insulin delivery and attain normal glucose in patients with type 1 diabetes. The recent years have seen an increase in the use of this technology for patients with type 2 diabetes. This article summarizes the clinical studies evaluating insulin pump use in patients with type 2 diabetes and discusses the benefits and shortcomings of pump therapy in this population. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Zohar Landau
- Pediatric Endocrine and Diabetes Unit, E. Wolfson Medical Center, Holon, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itamar Raz
- Diabetes Unit, Department of Internal Medicine, Hadassah University Hospital, Jerusalem, Israel
| | - Julio Wainstein
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Diabetes Unit, Wolfson Medical Center, Holon, Israel
| | - Yosefa Bar-Dayan
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Diabetes Unit, Wolfson Medical Center, Holon, Israel
| | - Avivit Cahn
- Diabetes Unit, Department of Internal Medicine, Hadassah University Hospital, Jerusalem, Israel
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14
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Cheng L, Xu M, Lin X, Tang J, Qi Y, Wan Y, Pan X, Chen X, Ren M, Yan L. The intriguing effects of time to glycemic goal in newly diagnosed type 2 diabetes after short-term intensive insulin therapy. Endocr J 2016; 63:739-46. [PMID: 27334121 DOI: 10.1507/endocrj.ej16-0154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Short-term intensive insulin therapy is effective for type 2 diabetes because it offers the potential to achieve excellent glycemic control and improve β-cell function. We observed that the time to glycemic goal (TGG) was adjustable. Original data of 138 newly diagnosed type 2 diabetic patients received intensive insulin therapy by continuous subcutaneous insulin infusion for 2-3 weeks were retrospectively collected. Subjects underwent an intravenous glucose tolerance test (IVGTT) and an oral glucose tolerance test (OGTT) pre and post treatment. The glycemic goal was achieved within 6 (4-8) days. Patients were divided into two groups by TGG above (TGG-slow) and below (TGG-fast) the median value. Patients in both groups had significantly better glycemic control. Compared with TGG-fast, TGG-slow required a few more total insulin and performed more improvement of HOMA-β and IVGTT-AUCIns, but less improvement of HOMA-IR and QUICKI. Multiple linear regression analysis revealed that TGG was always an explanatory variable for the changes (HOMA-β, IVGTT-AUCIns, HOMA-IR and QUICKI). The hypoglycemia prevalence was lower in TGG-slow (1.48% vs. 3.40%, P<0.01). Multivariate logistic regression analysis indicated that individuals in TGG-slow had a lower risk of hypoglycemia (adjusted OR, 0.700; 95% CI, 0.567-0.864; P<0.05). Multiple linear regression analysis confirmed that the ratio of the incremental insulin to glucose responses over the first 30 min during OGTT (ΔIns30/ΔG30), average insulin dose before achieving targets, initial insulin dose and LDL-c were independent predictors for TGG. It is intriguing to hypothesize that patients with fast time to glycemic goal benefit more in improving insulin sensitivity, but patients with slow time benefit more in improving β-cell function and reducing the risk of hypoglycemia.
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Affiliation(s)
- Lin Cheng
- Department of Endocrinology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
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15
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Kramer CK, Zinman B, Choi H, Retnakaran R. Predictors of sustained drug-free diabetes remission over 48 weeks following short-term intensive insulin therapy in early type 2 diabetes. BMJ Open Diabetes Res Care 2016; 4:e000270. [PMID: 27547422 PMCID: PMC4985916 DOI: 10.1136/bmjdrc-2016-000270] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/14/2016] [Accepted: 07/14/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE In early type 2 diabetes (T2DM), short-term intensive insulin therapy (IIT) for 2-4 weeks can decrease insulin resistance, reduce glucagonemia, improve β-cell function, and even induce a remission of diabetes that can last up to 1 year in some patients. However, little is known about the predictors of such a sustained remission. METHODS We evaluated data from the placebo arm of a double-blind randomized controlled trial in which patients with early T2DM (≤7 years duration) underwent 4 weeks of IIT (basal detemir, bolus aspart), followed by placebo therapy for 48 weeks (n=25). Participants underwent an oral glucose tolerance test every 12 weeks, enabling serial assessment of insulin sensitivity, α-cell response, and β-cell function. Diabetes remission was defined as A1c<6.5% on no medication for T2DM. RESULTS At 48 weeks post-IIT, 56% of the participants remained in remission. Comparison of remitters to non-remitters revealed no differences in waist, body mass index, insulin sensitivity (Matsuda index), or glucagon profile, either at baseline or over 48 weeks. Compared to non-remitters, the remission group had lower baseline A1c (p=0.006) and better baseline β-cell function (Insulin Secretion-Sensitivity Index-2) (p=0.01) that was then sustained across 48 weeks post-IIT (p=0.006). On logistic regression analyses, however, shorter duration of diabetes supplanted baseline A1c (p=0.24) and β-cell function (p=0.19) as an independent predictor of remission (p=0.04). In particular, diabetes duration <2 years predicted persistence of remission (p=0.006). CONCLUSIONS The key determinant of the likelihood of inducing sustained drug-free diabetes remission with short-term IIT is early intervention, particularly within the first 2 years after diagnosis. TRIAL REGISTRATION NUMBER ClinicalTrials.Gov NCT01270789; Post-results.
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Affiliation(s)
- Caroline K Kramer
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
| | - Bernard Zinman
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Haysook Choi
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
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