Blood glucose levels during early intensive insulin therapy predict glycemic remission

Abstract

Objective To investigate blood glucose profiles of patients with type 2 diabetes mellitus during short-term intensive insulin therapy and to analyze the relationship between blood glucose levels and glycemic remission. Methods A total of 266 patients with newly diagnosed type 2 diabetes who accepted short-term insulin pump therapy in the Department of Endocrinology in the First Affiliated Hospital of Sun Yat-sen University during 2001 to 2014 were included in this study. All patients accepted 2- 3 weeks of short-term insulin pump therapy after diagnosis. They were followed-up for 1 year after the cessation of the pump. Subjects were divided into instant remission group (187 patients, 127 men and 60 women) and instant non-remission group(79 patients, 47 men and 32 women) according to whether they could be relieved immediately after the treatment. According to the follow-up one year, subjects were divided into long-term remission group (127 patients, 89 men and 38 women) and non-remission group(139 patients, 85 men and 54 women). The capillary blood glucose profiles were recorded, relationship between blood glucose levels, standard deviation of blood glucose level and glycemic remission was analyzed. Difference between two groups was analyzed by t test. Logistics regression analysis and Cox regression analysis were used to analyze the influencing factors of glycemic remission. Results Mean blood glucose (MBG) after achieving glycemic targets was (6.2±0.6) mmol/L in all subjects. Instant glycemic remission rate after the cessation of the pump was 70.3% (187/266), one year remission rate was 47.7% (127/266). Compared with instant non-remission group, MBG was lower in instant remission group [(6.1±0.6)vs (6.6±0.7) mmol/L, t= 6.026, P<0.05]. Multivariate logistics regression analysis showed that immediate glycemic remission rate was reduced by 65% (OR=0.350, 95% CI:0.192- 0.638, P<0.05) for every 1 mmol/L increase in MBG. Compared with non-remission group, MBG was lower in one-year remission group [(6.0 ± 0.5)vs(6.5 ± 0.7) mmol/L, t=6.147, P<0.05]. Multivariate regression analysis showed that MBG [OR=0.388, 95% CI(0.224- 0.670), P<0.05] was a predictor of 1-year remission. The risk of recurrence of hyperglycemia in one year increased by 0.814 fold [HR=1.814, 95%CI(1.333-2.469), P<0.05] for every 1 mmol/L increase in MBG. If mean 2-hour postprandial blood glucose and mean fasting blood glucose were substituted for MBG in the analysis, mean 2-hour postprandial blood glucose [OR=0.530, 95%CI(0.368-0.753), P<0.05], but not mean fasting blood glucose was an independent predictor of one year glycemic remission. Conclusions Stricter glycemic control during maintenance phase of short-term intensive insulin therapy in newly diagnosed type 2 diabetes mellitus patients is associated with higher remission rate after treatment. Key words: Diabetes mellitus, type 2; Blood glucose; Insulin pump; Glycemic remission