Abstract
BACKGROUND:In the UK Prospective Diabetes Study (UKPDS), many subjects maintained glycemic goal (HbA1c < 7.0%) at 9 years, showing that β-cell function was preserved and that the initial decline in β-cell function recovered with sulphonylureas. Moreover, obese subjects using high daily doses of insulin for several years rarely require insulin or oral hypoglycemic agents to maintain their glycemic goal following weight loss achieved by gastric bypass surgery. Thus, declining β-cell function during the course of type 2 diabetes mellitus (T2DM) is neither universal nor permanent.OBJECTIVE:To assess β-cell function in morbidly obese subjects before insulin withdrawal and on attaining the glycemic goal with weight loss and oral agents.MATERIALS AND METHODS:Serum C-peptide (CPEP) and glucose (G) concentrations were determined up to 180 min during an oral glucose tolerance test (OGTT) with 75 glucose in 10 obese men with T2DM, before insulin withdrawal, and on achieving the glycemic goal with metformin, glimepiride, and weight loss. Ten age-matched healthy men participated as controls. Cumulative responses (CR) of CPEP and G were calculated by adding differences between the level at each time-period during OGTT and fasting (F) concentration. β-Cell function was expressed as the FCPEP as well as the insulinogenic index (CRCPEP/CRG). Insulin sensitivity was determined as FCEP × FG.RESULTS:FCPEP was decreased, though still present, prior to insulin withdrawal. Moreover, on attaining the glycemic goal over 6-9 months, FCPEP, CRPEP/CRG, and FCPEP × FG improved markedly (P < 0.001).CONCLUSION:Decline in β-cell function in morbidly obese T2DM may not be progressive and is reversible on improving insulin sensitivity and on eliminating the inhibition by exogenous insulin.
Highlights
Introduction βCell dysfunction and insulin resistance are known to be the two major mechanisms involved in the pathophysiology of type 2 diabetes mellitus (T2DM)
This study demonstrates that reinitiation of oral agents and weight loss can help subjects in attaining the desirable glycemic goal without the need for insulin administration
This finding is consistent with previous observations that reinitiation of oral agents, including sulfonylureas, either reduced the daily insulin requirement or totally abolished the need for exogenous insulin.[20,21,22,23,24,25,26]
Summary
Introduction βCell dysfunction and insulin resistance are known to be the two major mechanisms involved in the pathophysiology of type 2 diabetes mellitus (T2DM). [7,8] Several other studies have documented an improvement in insulin secretion after administration of sulfonylureas as well as diazoxide;[9,10,11] β-cell recovery is noted with the weight loss that follows gastric bypass surgery in morbidly obese subjects with T2DM who have been using high-dose insulin for several years.[12,13,14,15] a recent study clearly demonstrated that β-cell failure in T2DM may be neither universal nor inevitable.[16] this study was conducted to determine the insulin secretion prior to and after withdrawal of exogenous insulin, while attaining desirable glycemic control (HbA1c ≤ 7.0%) with initiation of oral hypoglycemic drugs as well as weight loss. Obese subjects using high daily doses of insulin for several years rarely require insulin or oral hypoglycemic agents to maintain their glycemic goal following weight loss achieved by gastric bypass surgery.
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