Young onset type 2 diabetic patients might be more sensitive to metformin compared to late onset type 2 diabetic patients

Feng-Fei Li,Xiao-Fang Zhai,Dan-Feng Zhang,Jin-Dan Wu,Xiao-Fei Su,Lei Ye,Bing-Li Liu,Mao-Yuan Chen,Jian-Hua Ma,Guo-Ping Yin

doi:10.1038/s41598-017-16658-x

Feng-Fei Li, Xiao-Fang Zhai + Show 8 more

Open Access

https://doi.org/10.1038/s41598-017-16658-x

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Abstract

It is unknown whether YOD (young onset diabetes) and LOD (late onset diabetes) require similar insulin doses for intensive insulin therapy with a metformin add-on to achieve glycemic control. We analyzed data from our two previously performed randomized, controlled open-label trials. Patients were randomized to receive either continuous subcutaneous insulin infusion (CSII) therapy or CSII combined with metformin therapy for 4 weeks. The studies concentrated on the differences in the insulin doses used for the two groups. We included 36 YOD (age < 40 yrs) and 152 LOD (age > 40 yrs) patients. YOD patients who received metformin combined with CSII therapy required significantly lower insulin doses to maintain euglycemic control compared to patients with LOD. A multivariate analysis, controlled for gender and the fasting blood concentration, was performed to determine the significance of the differences between groups, particularly with respect to the total and basal insulin doses. There was a trend toward improvement in β-cell function and insulin resistance in terms of ΔHOMA-B and ΔHOMA-IR in patients with YOD compared to those with LOD. Newly diagnosed T2D patients with YOD required significantly lower insulin doses, particularly basal insulin doses, to maintain glycemic control compared to the LOD patients.

Highlights

Patients with young-onset type 2 diabetes (YOD), defined as those less than 40 years old[1,2] at diagnosis, have more difficulty with glycemic and lipid control compared to older onset type 2 diabetes (T2D) patients: young-onset type diabetes (YOD) patients have higher HbA1c values and LDL cholesterol[2]
We have analyzed the results according to age, and we report that patients with YOD were more sensitive to a metformin combination with Continuous Subcutaneous Insulin Infusion (CSII) therapy in terms of requiring significantly lower insulin doses to maintain euglycemic control compared to those with a later age of onset
The improvement in β-cell function and decreased insulin resistance, not statistically significant, might be attributed to the possibility that patients with YOD might be sensitive to metformin when insulin doses are lowered to maintain glycemic control. The data of this current study indicated that newly diagnosed T2D patients with YOD had a significant increase in metformin sensitivity, which manifested itself when lowering insulin doses to maintain glycemic control compared to those with a later age of onset of diabetes

Summary

Introduction

Patients with young-onset type 2 diabetes (YOD), defined as those less than 40 years old[1,2] at diagnosis, have more difficulty with glycemic and lipid control compared to older onset type 2 diabetes (T2D) patients: YOD patients have higher HbA1c values and LDL cholesterol[2]. Patients with YOD may have a higher risk of complications compared to those with T2D of later onset[3] and T1D4 This has been shown to be relevant for ischemic heart disease, neuropathy[5], retinopathy[2], and cardiovascular-renal events with YOD6. More than half of the patients with newly diagnosed T2D responded well to Continuous Subcutaneous Insulin Infusion (CSII) therapy in terms of improvements in β-cell function and glycemic control for 1 year after cessation of therapy[10]. Metformin combined with CSII therapy was reported to have the ability to shorten the time required to achieve euglycemic control, lower the daily insulin dose, and promote an improvement in β cell function[25]

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