β-Cell function in postmenopausal women with isolated post-challenge hyperglycemia

BACKGROUND

Isolated post-challenge hyperglycemia (IPH) is an early stage of type 2 diabetes mellitus (T2DM), with fasting glucose <126 mg/dL and 2-h glucose ≥200 mg/dL. Observations of insulin secretion profile in subjects with IPH may provide an insight into the pathogenesis of T2DM in older women.

METHODS

We recruited 555 naturally postmenopausal women without a history of T2DM to the present study. All participants received a 75-g oral glucose tolerance test to determine whether they had IPH. General linear models were used to compare differences in glucose metabolism among subjects.

RESULTS

Early phase insulin responses to oral glucose were significantly decreased in women with IPH versus those with impaired glucose tolerance (IGT) and normal glucose tolerance (geometric mean [95% confidence interval] insulinogenic index 61 [54-79] vs 90 [83-97] and 105 [96-116], respectively; P  < 0.0001). In addition, there were significant decreases in late-phase insulin release as metabolic status shifted from normal glucose tolerance to IGT to IPH. In the present cohort, the relative contribution of early insulin secretion to 2-h glucose was no longer significant ( P  = 0.15) after multiple factors, including indicators of insulin resistance and late-phase insulin release, were entered into the regression model simultaneously.

CONCLUSIONS

The results demonstrate that postmenopausal women with IPH are characterized by impaired β-cell function. There were significant decreases in early and late-phase insulin release as glucose intolerance escalated. Disturbance in β-cell function seems to be an important factor associated with early T2DM in postmenopausal women.

Improving postprandial hyperglycemia in patients with type 2 diabetes already on basal insulin therapy: Review of current strategies

A large number of patients with type 2 diabetes (T2D) on basal insulin do not reach their HbA1c goals and require additional therapy to address postprandial hyperglycemia. Guidelines from expert bodies have outlined several approaches to accomplish postprandial glucose (PPG) control, and recent literature suggests several more. This article provides strategies for primary care physicians caring for patients with T2D who do not achieve glycemic control with basal insulin alone. Current treatment guidelines and strategies for improving PPG control are reviewed, including the efficacy, safety, and cost-effectiveness of rapid-acting insulin (RAI) analogs, premixed insulin, glucagon-like peptide-1 (GLP-1) receptor agonists (RAs), dipeptidyl peptidase 4 inhibitors, sodium-glucose cotransporter 2 inhibitors, and α-glucosidase inhibitors. Other approaches, such as combinations of newer basal insulin plus RAI and a fixed-ratio combination of basal insulin and a GLP-1 RA, are also described.

Comparison of insulin lispro mix 25 with insulin lispro mix 50 as insulin starter in Chinese patients with type 2 diabetes mellitus (CLASSIFY study): Subgroup analysis of a Phase 4 open-label randomized trial

BACKGROUND

Premixed insulins are recommended starter insulins in Chinese patients after oral antihyperglycemic medication (OAM) failure. In the present study, we compared the efficacy and safety of insulin lispro mix 25 (LM25) twice daily (b.i.d.) and insulin lispro mix 50 (LM50) b.i.d. as a starter insulin regimen in Chinese patients with type 2 diabetes mellitus (T2DM) who had inadequate glycemic control with OAMs.

METHODS

The primary efficacy outcome in the present open-label parallel randomized clinical trial was change in HbA1c from baseline to 26 weeks. Patients were randomized in a ratio of 1:  1 to LM25 (n = 80) or LM50 (n = 76). A mixed-effects model with repeated measures was used to analyze continuous variables. The Cochran-Mantel-Haenszel test with stratification factor was used to analyze categorical variables.

RESULTS

At the end of the study, LM50 was more efficacious than LM25 in reducing mean HbA1c levels (least-squares [LS] mean difference 0.48; 95 % confidence interval [CI] 0.22, 0.74; P < 0.001). More subjects in the LM50 than LM25 group achieved HbA1c targets of <7.0 % (72.4 % vs 45.0 %; P = 0.001) or ≤6.5 % (52.6 % vs 20.0 %; P < 0.001). Furthermore, LM50 was more effective than LM25 at reducing HbA1c in patients with baseline HbA1c, blood glucose excursion, and postprandial glucose greater than or equal to median levels (P ≤ 0.001). The rate and incidence of hypoglycemic episodes and increase in weight at the end of the study were similar between treatment groups.

CONCLUSIONS

In Chinese patients with T2DM, LM50 was more efficacious than LM25 as a starter insulin.