Fasting Plasma Glucose Indicates Reversibility of Acute Insulin Response after Short-Term Intensive Insulin Therapy in Patients with Type 2 Diabetes of Various Duration

Abstract

Objective: In patients with early type 2 diabetes, short-term intensive insulin therapy (SIIT) reverses ß cell dysfunction measured by acute insulin response (AIR). However, the complicated procedures limit large-scale use of AIR. Also unclear is whether SIIT is effective in patients with longer duration. This study is performed to assess fasting indicators estimating recovery of AIR after SIIT for type 2 diabetes of various duration. Research Design and Methods: Patients with type 2 diabetes (n=62) who had poor glycemic control were enrolled. Near-nomoglycaemia was achieved and maintained for 7 days with insulin pump. AIR was measured by intravenous tolerance tests before and after SIIT. Results: Both fasting plasma glucose (FPG, 12.0 ± 3.0 vs. 7.71± 1.6 mmol/L, P<0.001) and 2h-postprandial glucose (17.3 ± 5.2 vs. 11.5 ± 3.7 mmol/L, P<0.001) decreased significantly after SIIT. AIR was improved from -16.7 (-117.4, 52.4) pmol/L·min to 178.7 (31.8, 390.7) pmol/L·min (P<0.001). Increase of AIR (?AIR)was observed in all disease duration categories (329.2±380.6, 312.8±347.8, and 123.8 ±186.3 pmol/L·min for patients with disease duration of <2 years, 2-6 years, and >6 years respectively, P=0.10). AIR was almost absent when FPG was over 10 mmol/L. However, when FPG after SIIT was less than 10 mmol/L it was negatively associated with AIR (R= -0.53, P<0.001) and ?AIR (R= -0.52, P<0.001). In multivariate analysis, AIR after the therapy and ?AIR could be estimated as follows: Estimated AIR (pmol/L·min) = 447.6 × baseline fasting C peptide (nmol/L) - 138.0× FPG after SIIT (mmol/L) + 925.2 (R2=0.42); estimated ?AIR (pmol/L·min) = 401.4 × baseline fasting C peptide (nmol/L) - 136.8 × FPG after SIIT (mmol/L) -357.6 × HDL-C after SIIT (mmol/L) + 1380.0(R2=0.50). Conclusions: Recovery of AIR could be obtained in patients with various duration of type 2 diabetes, and it could be estimated conveniently by FPG and other fasting indicators. Disclosure L. Liu: None. S. Yang: None. J. Liu: None. L. Hai: None. J. Liu: None. Y. Li: None.