Effect of Hypoglycemia during Intensive Insulin Therapy on Long-Term Glycemic Control in Patients with Newly Diagnosed Type 2 Diabetes

Abstract

Aims: Short-term intensive insulin therapy induces long-term drug-free euglycemic remission in half of patients with newly diagnosed type 2 diabetes mellitus (T2DM) but causes an increased risk of hypoglycemia. Studies identifying the impact of hypoglycemia are necessary. Methods: We analyzed data from three randomized prospective trials conducted at our institution from 2002 to 2015. A continuous subcutaneous insulin infusion (CSII) was provided to achieve the glycemic goals and then maintained for 14 days. Results: Patients who attained one-year drug-free glycemic remission were younger (48.06±9.85 vs. 50.95±11.70 years, P=0.037) and had a higher body mass index (BMI) (25.53±3.52 vs. 24.66±3.20 kg/m2, P=0.046) than those who did not. Notably, the median number of episodes of mild hypoglycemia with nadir glucose values of 3.0-3.9 mmol/L was higher in the remission group than in the non-remission group (5 (6) vs. 2 (5), P<0.001). However, the number of episodes of clinically significant hypoglycemia (<3.0 mmol/L) was insignificantly lower in the remission group (0 (1) vs. 0 (1), P=0.273). Patients with higher glucose levels (glycated hemoglobin (HbA1c), fasting plasma glucose (FPG) and postprandial glucose (PPG)) and lower ?-cell functions (homeostasis model assessment of ?-cell function (HOMA-B)) at baseline faced a greater risk of clinically significant hypoglycemia (OR=2.02, 95% CI 1.40-2.92, P<0.001). According to the logistic regression analysis, mild hypoglycemic episodes were positively and independently related to long-term glycemic remission. Conclusions: Mild hypoglycemic episodes during CSII therapy are related to better long-term drug-free glycemic remission in patients with newly diagnosed T2DM. However, clinically significant hypoglycemia is not correlated and should be avoided. Disclosure L. Xu: None. Y. Li: None.