Short-term Continuous Subcutaneous Insulin Infusion Research Articles

Short-time intensive insulin therapy upregulates 3 beta- and 17 beta-hydroxysteroid dehydrogenase levels in men with newly diagnosed T2DM.

ObjectiveOur previous study has found that short-term intensive insulin therapy in patients with newly diagnosed type 2 diabetes mellitus (T2DM) increased serum testosterone levels, but the underlying mechanisms remain unclear.Design and methodsIn this self-controlled study, 43 men with newly diagnosed drug naïve T2DM, aged 18-60 years, with HbA1c >9.0% were treated with continuous subcutaneous insulin infusion (CSII) to normalize blood glucose within one week. Venous blood specimens were collected for measuring of serum total testosterone, dehydroepiandrosterone sulfate (DHEA-S), 3β- and 17β-hydroxysteroid dehydrogenase (3β- and 17β-HSD) concentrations before and after insulin therapy.ResultsTestosterone increased from 13.0 (11.3, 14.6) nmol/L to 15.7 (13.9, 17.5) nmol/L after intensive insulin therapy (p<0.001), while the levels of DHEA-S decreased significantly after treatment (from 6.5 (5.7, 7.3) μmol/L to 6.0 (5.3, 6.7) μmol/L, p=0.001). The ratio of testosterone/DHEA-S increased significantly (2.4 (2.0, 2.8) vs. 3.1 (2.6, 3.7) nmol/μmol, p<0.001). After blood glucose normalization with the short-term CSII therapy, 3β-HSD increased from 11.0 (9.5, 12.5) pg/mL to 14.6 (13.5, 15.7) pg/mL, p=0.001, and 17β-HSD increased from 20.7 (16.3, 25.2) pg/mL to 28.2 (23.8, 32.5) pg/mL, p=0.009.ConclusionsBlood glucose normalization via short-term intensive insulin therapy increases plasma total testosterone levels in men with newly diagnosed type 2 diabetes, associated with a decreased level of DHEA-S, probably because of the enhanced conversion from DHEA to testosterone catalyzed by 3β-HSD and 17β-HSD.

777-P: Short-Term Continuous Subcutaneous Insulin Infusion Treatment Improves Peripheral Autonomic Neuropathy in Type 2 Diabetes

Background: Short-term continuous subcutaneous insulin infusion treatment (CSII) in patients with newly diagnosed type 2 diabetes (T2DM) can improve β-cell function and insulin sensitivity, which results in long-term remission. However, the effect of CSII on peripheral neuropathy is rarely studied. Methods: 63 T2DM patients (HbA1c&amp;gt;9%) were hospitalized and treated with CSII for 2 weeks. Peripheral autonomic neuropathy was measured by SUDOSCAN, which provides an age adjusted electrochemical skin conductance (ESC) composite score incorporating hands/feet ESC measurements, with a score ≤60 indicating sudomotor dysfunction. Blood glucose, HbA1c, C-peptide and SUDOSCAN were measured before and after CSII. HOMA-B was used for assessment of β-cell function. Results: The average HbA1c of included patients was 10.5% with median duration of T2DM was 3.5 years. There were 27 (42.9%) patients who had sudomotor dysfunction at baseline. After 2 weeks of CSII, the proportion of sudomotor dysfunction (42.9% vs. 31.7%, P=0.020) was significantly deceased along with significantly improved HbA1c (10.0±1.9 vs. 8.1±1.0, P&amp;lt;0.001) and HOMA-B [22.0 (IQR 12.1-37.0) vs. 56.9 (IQR 42.4-81.8) , P&amp;lt;0.001]. Correlation analysis revealed that higher ESC composite score was correlated with better HOMA-B after CSII (r=0.445, P=0.015) . Conclusion: Peripheral autonomic neuropathy could be improved by CSII in T2DM. The improvement of β-cell function could be responsible for the amelioration of peripheral nerve function. Keywords: Short-term continuous subcutaneous insulin infusion treatment; peripheral autonomic neuropathy; type 2 diabetes; β-cell function Disclosure J.Jin:None. Funding National Key R&amp;D Program of China (2018YFC1314100) ; the Key-Area Research and Development Program ofGuangdong Province (2019B020230001) ; the China Postdoctoral ScienceFoundation (2018M640871)

Association of Body Fat Percentage with Time in Range Generated by Continuous Glucose Monitoring during Continuous Subcutaneous Insulin Infusion Therapy in Type 2 Diabetes.

Background Obesity is a crucial risk factor associated with type 2 diabetes mellitus (T2DM). Excessive accumulation of body fat may affect the glycemia control in T2DM. This study investigated the relationship between body fat percentage and time in range (TIR) assessed by continuous glucose monitoring (CGM) during short-term continuous subcutaneous insulin infusion (CSII) therapy in T2DM patients. Method A total of 85 T2DM patients were recruited in this cross-sectional study. All participants underwent 72 h CGM period during short-term CSII therapy. TIR was defined as the percentage of time spent within the target glucose range of 3.9-10.0 mmol/L. Body composition was measured using bioelectrical impedance analysis (BIA) and overfat was defined as an amount of body fat of at least 25% of total body mass for men or at least 30% for women. Multiple linear regression models were used to evaluate the independent association of body fat percentage with TIR after adjusting for confounding factors. Results Compared with normal fat T2DM patients, individual with a higher body fat percentage exhibited lower levels of TIR (P = 0.004) and higher 72 h mean blood glucose (72 h MBG) (P = 0.001) during short-term CSII treatment. The prevalence of overfat assessed by body fat percentage decreased with the ascending TIR tertiles (P < 0.05). Multiple linear regression analysis indicated that body fat percentage was significantly associated with TIR independent of age, gender, diabetes duration, HbA1c, and BMI (P = 0.043). Conclusions Body fat percentage was significantly associated with TIR in T2DM during short-term CSII therapy. Reduction of body fat may be an important therapeutic target to improve glycemic control in high body fat T2DM patients, who may benefit less from intensive insulin treatment.

Hypoglycemia during Short-Term Intensive Insulin Therapy and Its Association with Long-Term Glycemic Remission in Patients with Newly Diagnosed Type 2 Diabetes.

Background Short-term intensive insulin therapy induces long-term glycemic remission in half of patients with newly diagnosed type 2 diabetes. The concomitant hypoglycemia needs further analysis. Methods We collected data from three randomized trials conducted with the same inclusion and exclusion criteria at our institution from 2002 to 2015. Continuous subcutaneous insulin infusion (CSII) was provided to achieve the glycemic goals within a week and then maintained for 14 days. Hypoglycemia episodes during short-term treatment and the one-year drug-free glycemic remission were observed. Results A total of 244 patients were included. The per day episode of mild hypoglycemia (3.0-3.9 mmol/L) was higher in the remission group than in the nonremission group (0.26 ± 0.20 vs. 0.18 ± 0.21, P = 0.005). However, a moderate hypoglycemia episode (<3.0 mmol/L) per day was insignificantly lower in the remission group (0.02 ± 0.04 vs. 0.03 ± 0.04, P = 0.005). However, a moderate hypoglycemia episode (<3.0 mmol/L) per day was insignificantly lower in the remission group (0.02 ± 0.04 vs. 0.03 ± 0.04, P = 0.005). However, a moderate hypoglycemia episode (<3.0 mmol/L) per day was insignificantly lower in the remission group (0.02 ± 0.04 vs. 0.03 ± 0.04, P = 0.005). However, a moderate hypoglycemia episode (<3.0 mmol/L) per day was insignificantly lower in the remission group (0.02 ± 0.04 vs. 0.03 ± 0.04, Conclusions Mild hypoglycemic episodes during the continuing insulin dose reduction period indicate a long-term drug-free euglycemic remission in patients with newly diagnosed type 2 diabetes. However, the insulin dosage should be reduced even more quickly in the future treatment to decrease the potential harms.

Efficacy of Vildagliptin Added to Continuous Subcutaneous Insulin Infusion (CSII) in Hospitalized Patients with Type 2 Diabetes.

IntroductionThe aim of this study was to compare the efficacy of vildagliptin as add-on therapy to short-term continuous subcutaneous insulin infusion (CSII) with CSII monotherapy in hospitalized patients with type 2 diabetes mellitus (T2DM).MethodsA total of 200 hospitalized patients with inadequately controlled T2DM were randomized into groups, with one group receiving CSII monotherapy (CSII group, n =100) and the other group receiving CSII plus vildagliptin as add-on (CSII + Vig group, n = 100). Of these, 191 completed the 7-day trial (CSII group, n = 99; CSII + Vig group, n = 92) and included in the analysis. The glycemic control and variability of the patients were measured using all-day capillary blood glucose (BG) monitoring. Weight and fasting C-peptide levels were evaluated before and after the interventions.ResultsMean BG concentrations during the whole treatment period were lower and the time to reach target BG was reduced in the CSII + Vig group compared with the CSII group (9.89 ± 3.37 vs. 9.46 ± 3.23 mmol/L, P < 0.01; 129 ± 4 vs. 94 ± 5 h, P < 0.01, respectively). Similarly, the indicators of glycemic variability, namely the standard deviation of BG and the largest amplitude of glycemic excursion, were significantly decreased in the CSII + Vig group compared with the CSII group (2.68 ± 1.05 vs. 2.39 ± 1.00 mmol/L, P < 0.01; 7.19 ± 2.86 vs. 6.23 ± 2.73 mmol/L, P < 0.01, respectively).ConclusionsShort-term CSII with vildagliptin as add-on therapy may be an optimized treatment for hospitalized patients with T2DM compared with short-term CSII monotherapy.

Comparing the Efficacy and Safety Between Short-term Continuous Subcutaneous Beinaglutide Injection and Continuous Subcutaneous Insulin Infusion (CSII) for Newly Diagnosed Type 2 Diabetes

Comparing the Efficacy and Safety Between Short-term Continuous Subcutaneous Beinaglutide Injection and Continuous Subcutaneous Insulin Infusion (CSII) for Newly Diagnosed Type 2 Diabetes - Full Text View.

1062-P: Insulin Requirement Profiles of Short-Term Continuous Subcutaneous Insulin Infusion Therapy in Chinese Patients with Type 2 Diabetic Nephropathy

Our study aims to explore the insulin requirement profiles of short-term intensive continuous subcutaneous insulin infusion (CSII) in Chinese patients with type 2 diabetic nephropathy. CSII was applied in 68 patients with diagnosed type 2 diabetic nephropathy (using Paradigm 712, Medtronic). Daily insulin doses were titrated and recorded to achieve and maintain target glucose levels (FPG&amp;lt;7.0mmol/L and 2hPBG&amp;lt;10mmol/L) for 8-12 days. The patients were 60.0±13.1 years in age, 45.6% female (n=31), mean duration 11.3±7.2 years, BMI 25.0±3.3 kg/m2, mean HbA1c of 9.4±2.5%, median urinary microalbumin/creatine 78.2 mg/g (inter-quartile range 36.0-274.6 mg/g), and median creatine 72.0umol/l (inter-quartile range 53.5-110.8 umol/l). At the first day after the glycemic targets were achieved (Day1), total daily insulin dose (TDD), total basal and premeal dose were 44.3±17.5 IU (0.67±0.27 IU/kg), 19.6±9.2 IU (0.30±0.14 IU/kg) and 24.7±10.3 IU (0.37±0.15 IU/kg), respectively. At the end of CSII therapy, TDD was 43.7±18.1 IU (0.66±0.28 IU/kg). Total basal dose and total pre-meal dose were 19.2±9.0 IU (0.29±0.14 IU/kg, P&amp;gt;0.05 compared with Day1) and 24.5±11.2 (0.37±0.17 IU/kg, P &amp;gt; 0.05 compared with Day1), respectively. The ratio of basal insulin dose to TDD were 44%±11% at Day1 and 44%±12% at the end, respectively. The ratio of basal insulin dose to TDD at day 1 were 45%±11% and 40%±9% in subjects with eGFR &amp;gt;60ml/min (n=48) or eGFR &amp;lt;60ml/min (n=20), respectively (P=0.11). The ratio of basal insulin dose to TDD at day 1 were 49%±18% and 39%±12% in subjects with eGFR 60-90 ml/min or eGFR &amp;lt;30ml/min, respectively (P=0.041). The TDD at Day1 were 45.8±12.4 IU in subjects with 40.9±26.1 IU in subjects with eGFR &amp;gt;60ml/min or eGFR &amp;lt;60ml/min, respectively (P&amp;gt;0.05). These results suggested the ratio of basal insulin dose to TDD might be decreased while eGFR declined in patients with type 2 diabetic nephropathy. Disclosure S. Lin: None. K. Zhang: None. P. Li: None. K. Fang: None. L. Zeng: None. Funding Science and Technology Planning Project of Guangdong Province (2017A020215026); Medical Scientific Research Foundation of Guangdong Province (A2017314)

2325-PUB: Estimation Formula for the Long-Term Glycemic Remission in Patients with Newly Diagnosed Type 2 Diabetes Receiving Short-Term Intensive Insulin Therapy

Aims: Half of the patients with newly diagnosed type 2 diabetes who received short-term continuous subcutaneous insulin infusion (CSII) were able to achieve a long-term drug-free glycemic remission. It is meaningful to develop an estimation formula to predict the glycemic remission. Methods: We collected data from three prospective trials conducted from 2002 to 2015. A 2∼3 weeks of CSII was provided for the patients with newly diagnosed diabetes to achieve and maintain normal glucose. The one-year drug-free remission rate was observed. Differences between patients with remission and those without remission were evaluated. Estimation formula was developed by using the logistic regression models. The receiver operating characteristic (ROC) curve was used to determine the sensitivity and specificity of the estimation formula at different score cutoffs. Results: Data of 244 patients were analyzed. After comparisons, age, gender, body mass index (BMI), high-density lipoprotein cholesterol (HDL-C), red cell distribution width (RDW), ratio of fasting plasma glucose to HbA1c (FPG/HbA1c) at baseline, FPG, postprandial plasma glucose (PPG) and the homeostasis model assessment of insulin resistance (HOMA-IR) after short-term CSII treatment were analyzed. We developed a formula as follows: R=11.936-1.626*HDL-1.56*FPG/HbA1c-0.14*RDW-0.496*FPG’ (FPG’ means FPG after short-term CSII). When R is greater than 0.5, it indicates a possible glycemic remission. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 82.8%, 62.2%, 73.7%, 73.3% and 74.2%, respectively. Conclusions: We provide a prediction formula for long-term glycemic remission. For those who is predicted glycemic non-remission, sequential treatment after CSII secession may be beneficial for the long-term glucose control. Disclosure L. Xu: None. L. Liu: None. X. Wan: None. Z. Huang: None. Y. Li: None.

The effects of short-term continuous subcutaneous insulin infusion treatment on fasting glucagon-like peptide-1 concentrations in newly diagnosed type 2 diabetes

ObjectiveEarly short-term intensive insulin therapy in newly diagnosed type 2 diabetes patients shows benefit in glycemic control and β-cell function. Glucagon-like peptide-1 (GLP-1) plays an important role in glucose metabolism and development of type 2 diabetes. We did a study to observe the changes of GLP-1 and β-cell function after short-term continuous subcutaneous insulin infusion (CSII) treatment. MethodsA total of 66 subjects were enrolled, including 30 normal glucose tolerance controls (NGT) and 36 patients with newly diagnosed type 2 diabetes between October 2015 and July 2016. Fasting plasma glucose (FPG), insulin, and GLP-1 were measured in each subject. The patients underwent CSII treatment for 2 weeks, and then FBG, insulin, and GLP-1 were measured. HOMA-IR and HOMA-B were then calculated. ResultsAll patients achieved target glycemic control in two weeks. HOMA-IR and HOMA-B improved significantly after intensive interventions (p < 0.05). The GLP-1 concentration increased significantly in patients after treatment (p < 0.05). When grouped according to bodyweight and age in all patients, the HOMA-IR changed significantly in overweight and old age subgroups, the HOMA-B increased significantly in normal weight, overweight and middle age subgroups, and the GLP-1 concentration also increased significantly in overweight and middle age subgroups respectively (p < 0.05). ConclusionShort-term CSII treatment can obtain glycemic control target and recover β-cell function and GLP-1 secretion in newly diagnosed type 2 diabetes patients. The overweight and middle-aged patients may get more benefit from this treatment.

Baseline red blood cell distribution width predicts long-term glycemic remission in patients with type 2 diabetes.

We explored whether red blood cell distribution width (RDW), a routinely checked item of complete blood cell counts, was an indicator of long-term euglycemia remission in patients with type 2 diabetes after short-term continuous subcutaneous insulin infusion (CSII). We analyzed the original data of patients enrolled in three randomized control trials from 2002 to 2014. CSII was administered to drug-naїve patients with newly diagnosed type 2 diabetes to achieve and maintain euglycemia for 2weeks. A total of 185 patients were involved and 98 patients (52.97%) who achieved and maintained euglycemia for at least 12months were classified as the remission group, and the others as the non-remission group. Patients in remission group had a relatively lower value for baseline RDW (38.82±2.76vs 39.89±2.78fL, p=0.017) compared with those in non-remission group. A graded decrease of remission rate (67.50%, 55.00%, 53.66% and 30.77% for Quartile 1 to Quartile 4 respectively, P<0.05) was observed with the increasing of RDWs. The risk of hyperglycemic relapse was significantly increased for those in the highest quartile compared with the lowest (hazard ratio=2.68; 95% CI, 1.38-5.22). Those who achieved euglycemia within 7days or obtained a better fasting glucose after therapy had preferable remission rates. Patients with lower baseline RDWs are more likely to maintain a one-year euglycemia remission after short-term CSII. A faster normalization of glucose during treatment and a lower fasting glucose after therapy are correlated with a long-term glucose control.

Effects of Liraglutide Combined with Short-Term Continuous Subcutaneous Insulin Infusion on Glycemic Control and Beta Cell Function in Patients with Newly Diagnosed Type 2 Diabetes Mellitus: A Pilot Study.

The objective of this paper is to investigate the effects of liraglutide in combination with short-term continuous subcutaneous insulin infusion (CSII) therapy on glycemic control and beta cell function in patients with newly diagnosed type 2 diabetes mellitus (T2DM). Thirty-nine eligible newly diagnosed T2DM patients were recruited and randomized to receive either of two therapies: short-term CSII alone (CSII alone group) or CSII in combination with liraglutide (CSII + Lira group) for 12 weeks. Blood glucose control, homeostasis model assessment (HOMA) indices, and acute insulin response (AIR) were compared between the two groups. The patients in CSII + Lira group achieved euglycemia with equivalent insulin dosage in shorter time (1 (0) versus 2 (3) days, P = 0.039). HbA1c at the end of study was comparable between two groups (6.3 ± 0.7% versus 6.0 ± 0.5%, for CSII alone group and CSII + Lira group, resp., P = 0.325). The increment of AIR was higher in CSII + Lira group (177.58 (351.57) μU·min/mL versus 58.15 (51.30) μU·min/mL, P < 0.001). However, after stopping liraglutide, its effect on beta cell function disappeared completely. Liraglutide combined with short-term CSII was effective in further improving beta cell function, but the beneficial effects did not sustain after suspension of the therapy.

Improvement of β-cell function ameliorated glycemic variability in patients with newly diagnosed type 2 diabetes after short-term continuous subcutaneous insulin infusion or in combination with sitagliptin treatment: a randomized control trial.

Glycemic variability (GV) has been proposed as contributor to diabetes-related macrovascular complications. This randomized control trial evaluated a new combination therapy with continuous subcutaneous insulin infusion (CSII) plus sitagliptin (CSII + sitagliptin) vs. CSII only in terms of metabolic control, GV and β-cell function in patients with newly diagnosed type 2 diabetes (T2DM). 217 patients were randomized to two weeks of CSII (n = 108) or CSII + sitagliptin (n = 109) therapy. As a measure of GV, the coefficient of variation (CV) was computed from capillary blood glucose during the first and second week, respectively. β-cell function before and after treatment was determined with the Insulin Secretion-Sensitivity Index-2 (ISSI-2). Good metabolic controls were established with both therapies. CSII + sitagliptin therapy resulted in greater improvements in CV and ISSI-2 than CSII alone (all P = 0.000). For each group, change in CV was inversely correlated with change in ISSI-2 (r = -0.529, P = 0.000 and r = -0.433, P = 0.000, respectively). The multivariate regression analysis demonstrated that improved ISSI-2 was the only independent contributor to reduced CV in both groups (standardized β = -0.388, P = 0.004 and standardized β = -0.472, P = 0.000, respectively). Correction of β-cell function in newly diagnosed T2DM patients via use of either CSII or CSII + sitagliptin therapy was feasible in controlling GV to prevent secondary complications of T2DM. Moreover, CSII + sitagliptin therapy was superior to CSII monotherapy in terms of GV.

Short-Term Continuous Subcutaneous Insulin Infusion Combined with Insulin Sensitizers Rosiglitazone, Metformin, or Antioxidant α-Lipoic Acid in Patients with Newly Diagnosed Type 2 Diabetes Mellitus

Short-term continuous subcutaneous insulin infusion (CSII) in patients with newly diagnosed type 2 diabetes has been proved effective in improving metabolic control and β-cell function, thus inducing long-term drug-free remission. A randomized controlled trial was conducted to investigate whether CSII in combination with rosiglitazone, metformin, or α-lipoic acid separately brings about extra benefits. One hundred sixty patients with newly diagnosed type 2 diabetes were randomized to one of four treatment groups: CSII alone, CSII in combination with rosiglitazone or metformin for 3 months, or CSII with α-lipoic acid intravenous infusion for 2 weeks. Duration of CSII treatment was identical in the four groups. Glucose and lipid profiles, homeostasis model assessment (HOMA) indices, acute insulin response (AIR), intramyocellular lipid (IMCL) level, and malondialdehyde level were compared before and after intervention. The near-normoglycemia rate at the third month in CSII alone and that in combination with rosiglitazone, metformin, or α-lipoic acid was 72.5%, 87.5%, 90%, and 75%, respectively (metformin group vs. CSII alone, P=0.045). The metformin group achieved euglycemia in a shorter time (2.6 ± 1.3 vs. 3.7 ± 1.8 days, P=0.020) with less daily insulin dosage and was more powerful in lowering total cholesterol, increasing AIR and HOMA β-cell function, whereas reduction of IMCL in the soleus was more obvious in the rosiglitazone group but not in the metformin group. The efficacy of combination with α-lipoic acid was similar to that of CSII alone. Short-term CSII in combination with rosiglitazone or metformin is superior to CSII alone, yet the efficacy of the two differs in some way, whereas that with α-lipoic acid might not have an additive effect.

Attitudes Toward Diabetes Affect Maintenance of Drug-Free Remission in Patients With Newly Diagnosed Type 2 Diabetes After Short-Term Continuous Subcutaneous Insulin Infusion Treatment

OBJECTIVEShort-term intensive insulin treatment in patients with newly diagnosed type 2 diabetes can improve β-cell function and insulin sensitivity, which results in long-term remission without need for further antidiabetes medication. Patient attitudes toward their disease were assessed using the Diabetes Care Profile (DCP) tool to evaluate the potential impact on maintaining long-term remission.RESEARCH DESIGN AND METHODSNewly diagnosed patients with type 2 diabetes were recruited and treated with continuous subcutaneous insulin infusion (CSII) for 2–3 weeks. They were also invited to participate in diabetes self-management intervention during hospitalization and complete a DCP questionnaire on attitudes toward diabetes at baseline and 3, 6, and 12 months after suspension of CSII.RESULTSNear normoglycemia was achieved by 118 patients after short-term CSII, with 65 remaining in drug-free remission for >1 year. They had significantly better glycemic control and greater restoration of acute insulin response after CSII as well as higher educational attainment compared with patients experiencing relapse. They also achieved higher scores in positive attitude, (belief in) importance of care, care ability, self-care adherence, and less negative attitude. Differences between the two groups became greater over time. Cox proportional hazards model analysis indicated that greater self-care adherence (hazard ratio 0.184, P < 0.001) and homeostasis model assessment of insulin resistance before treatment (0.854, P = 0.053) were independent predictors for long-term remission, whereas elevated 2-h postprandial plasma glucose after CSII (1.156, P = 0.015) was a risk factor for relapse.CONCLUSIONSAttitudes toward diabetes affect long-term drug-free remission in newly diagnosed patients with type 2 diabetes after short-term CSII.

Effects of Short-Term Continuous Subcutaneous Insulin Infusion on Fasting Plasma Fibroblast Growth Factor-21 Levels in Patients with Newly Diagnosed Type 2 Diabetes Mellitus

BackgroundTo investigate the effects of short-term continuous subcutaneous insulin infusion (CSII) on plasma fibroblast growth factor-21 (FGF-21) levels in patients with newly diagnosed type 2 diabetes mellitus (nT2DM).MethodSixty-eight patients with nT2DM (nT2DM group), and 52 gender-, age- and body mass index (BMI) -matched normal glucose tolerance (NGT group) controls participated in the study. 30 nT2DM patients with FBG≥14.0 mmol/L were treated with CSII for 2 weeks, and were underwent a euglycemic–hyperinsulinemic clamp pre- and post-treatment. Plasma FGF-21 concentrations were measured with a commercial ELISA kit. The relationship between plasma FGF-21 levels and metabolic parameters was also analyzed.ResultsFasting plasma FGF-21 levels were higher in the nT2DM group than in NGT groups (1.60±0.08 vs. 1.13±0.26 µg/L, P<0.01). In nT2DM patients, fasting plasma FGF-21 concentrations were significantly decreased after CSII treatment for 2 weeks (1.60±0.08 vs.1.30±0.05 µg/L, P<0.05), accompanied by a significant increase in the whole body glucose uptake (M value) and blood glucose control. The changes in plasma FGF-21 levels (ΔFGF-21) were positively associated with the amelioration of insulin resistance shown by the changes in M value.ConclusionPlasma FGF-21 level is associated with whole body insulin sensitivity and significantly reduced following short-term CSII treatment.

Short-term continuous subcutaneous insulin infusion decreases the plasma vaspin levels in patients with type 2 diabetes mellitus concomitant with improvement in insulin sensitivity

To investigate the effects of short-term continuous subcutaneous insulin infusion (CSII) on plasma vaspin levels in patients with newly diagnosed type 2 diabetes mellitus (T2DM). Thirty patients with severe newly diagnosed T2DM, 37 subjects with impaired glucose tolerance (IGT) and 38 gender-, age- and body mass index (BMI)-matched normal GT (NGT) controls participated in the study. The T2DM group was treated with CSII for 2 weeks. Euglycemic-hyperinsulinemic clamps were performed in 16 subjects of the T2DM group. Plasma vaspin concentrations were measured with a commercial ELISA kit. The relationship between plasma vaspin levels and metabolic parameters was also analyzed. Fasting plasma vaspin levels were higher in the T2DM group than in IGT and NGT groups (1.83±0.55 vs 0.51±0.21 vs 0.53±0.24 μg/l, P<0.05), but there was no difference between IGT and NGT groups. In T2DM patients, fasting plasma vaspin concentrations were significantly decreased after CSII treatment for 2 weeks (1.83±0.55 vs 1.19±0.57 μg/l, P<0.05), accompanied by significant amelioration of insulin sensitivity and glucose control. The changes in plasma vaspin levels were positively associated with the amelioration of insulin resistance (IR) shown by the changes in homeostasis model assessment of IR. Plasma vaspin level is associated with IR and is significantly reduced following short-term CSII treatment.

Effects of a novel short-term continuous subcutaneous insulin infusion program evaluated by continuous glucose monitoring on young adult type 1 diabetic patients in Taiwan

The aim of this study is to evaluate the effectiveness of blood sugar control by a short-course reinforcement program, consisting of using continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) for young adult type 1 diabetic patients. Twenty-six pump-naïve type 1 diabetic patients were successively enrolled in two years. The mean disease duration was 13 years and the mean HbA1c was 8.8 %. Initially, a 3-day course of CGM was used to evaluate the baseline glycemic status of the subjects, followed by 6-day intensive insulin adjustment by CSII therapy. Thereafter, a second course of CGM was performed to evaluate the effectiveness of our outcomes in comparison to the initial measurements. All participants received necessary education and instruction as required throughout the course of the program. The glucose variability as measured by standard deviation of plasma glucose and mean amplitude of glucose excursion decreased significantly (67.8 ± 2.7 to 52.0 ± 1.8 mg/dL and 140.4 ± 6.5 to 105.5 ± 5.3 mg/dL, p < 0.001). The hypoglycemic events noted per patient were reduced by 46.4% (p = 0.003) and occurred significantly less often during nocturnal periods (-63.2%, p = 0.002). Following the adjustment, the mean daily insulin requirement was reduced by 28.05% (from 0.82 to 0.59 IU/kg) and the new proportion of 40% as basal insulin was found. The short-term CSII program provided significant improvement in blood sugar control for type 1 diabetic patients, by reducing hypoglycemic events, glucose excursion, and insulin dosage in our examined subjects.

Effects of short-term continuous subcutaneous insulin infusion on fasting plasma vaspin levels in patients with recent-onset type 2 diabetes mellitus

Objective To investigate the effects of short-term continuous subcutaneous insulin infusion (CSII) on plasma visceral adipose tissue-derived serine protease inhibitor ( vaspin ) levels in patients with recentonset type 2 diabetes mellitus, and to study the association between insulin sensitivity and vaspin levels.Methods Thirty patients with recent-onset type 2 diabetes mellitus were treated with CSII for 2 weeks.Euglycemic-hyperinsulinemic clamps (EHC) were performed to evaluate the insulin sensitivity in type 2 diabetes group. Plasma vaspin levels were measured by an ELISA kit. The association between plasma vaspin levels and metabolic parameters were analyzed. Results Fasting plasma vaspin levels were higher in type 2 diabetes than in impaired glucose regulation and normal glucose tolerance groups [( 1.83±0.55 vs 0. 43±0.21 and 0.56±0.26) ng/ml,P＜0.05]. With CSII,vaspin levels [( 1.19 ±0.57 vs 1.83 ±0.55 ) ng/ml, P＜0.05] and homeostasis model assessment for insulin resistance [HOMA-IR ,2.30 ( 1.09-7.2 ) vs 4.28 ( 1.7-6.47 ), P＜0.05] were significantly decreased,accompanied with an increase in glucose metabolic rate [(5. 10±0.51 vs 2.99±0.42 )mg·kg-1·min-1 ,P＜0.05] in type 2 diabetes group. Changes in circulating vaspin concentrations were correlated positively with changes in HOMA-IR. Conclusion In type 2 diabetic patients,elevated plasma vaspin levels are significantly decreased after CSII treatment. Vaspin may play a role in improving insulin sensitivity of diabetic humans. Key words: Serine protease inhibitor; Diabetes mellitus, type 2; Continuous subcutaneous insulin infusion; Euglycemic-hyperinsulinemic clamp

Insulin Requirement Profiles of Patients with Type 2 Diabetes After Achieving Stabilized Glycemic Control with Short-Term Continuous Subcutaneous Insulin Infusion

As in type 1 diabetes, continuous subcutaneous insulin infusion (CSII) therapy is emerging as a promising therapeutic option in type 2 diabetes. However, the insulin requirement profiles of patients with type 2 diabetes when treated via CSII with rapid-acting insulin analogs have not been well investigated. We examined insulin requirement profiles of type 2 diabetes patients (n = 300; age, 57.9 +/- 11.4 years; hemoglobin A1c [HbA(1c)], 9.1 +/- 2.2%) for 3 days after achieving normoglycemia via 1-2 weeks of CSII therapy. We also analyzed the total daily dose (TDD) of insulin-associated clinical and laboratory parameters at baseline. The mean TDD was 45.1 +/- 24.7 IU/day (range, 4.8-145.8 IU/day). The total daily bolus (TBo) (range 2.8-111.3 IU/day) was 64.1 +/- 12.1% of the TDD. The rates of infusion for day and night in total daily basal dose (TBa) were 0.74 +/- 0.35 and 0.41 +/- 0.32 IU/h, respectively. The dose ratio (in IU/day) was 2.7 : 1.9 : 1.6 : 1.8 : 1 (breakfast, lunch, and dinner bolus and day and night basal, respectively). After adjusting for age, gender, and body mass index, TDD was associated with HbA(1c), fasting and 2-h postprandial plasma glucose, fasting C-peptide, and carbohydrate-to-insulin ratio (P < 0.05). Initial TDD in type 2 diabetes patients on CSII showed a wide range of distribution with a TBo-to-TBa ratio >2.0 and was associated with parameters indicating glycemic control but not with body weight, suggesting that the currently used protocol in dose determination of insulin, including allocation of half of the TDD to TBa or weight-based determination of initial TDD, may need to be reexamined when treating type 2 diabetes with CSII therapy.

Influencing factors for the curative effects of short-term continuous subcutaneous insulin infusion on newly diagnosed type 2 diabetes

To investigate the effects of short-term continuous subcutaneous insulin infusion (CSII) on newly diagnosed type 2 diabetes and to identify the influencing factors for the curative effects of CSII. 138 newly diagnosed type 2 diabetic patients with fasting plasma glucose > 11.1 mmol/L were treated with CSII for 2 weeks. Intravenous glucose tolerance test (IVGTT) was performed before and after CSII. The target of glycemic control were fasting blood glucose < 6.1 mmol/L and postprandial blood glucose (PBG) < 8.0 mmol/L. The age, body mass index (BMI), fasting and postprandial plasma glucose, hemoglobin A(1C) (GHbA(1C)), Homa beta, Homa IR, area under the curve of insulin (AUC) during IVGTT were compared between the good glycemic control group and the inadequate glycemic control group. After 2 weeks' CSII treatment, good glycemic control was achieved in 126 patients (group A) but not in the remaining 12 patients (group B). There were no differences in age, BMI, postprandial plasma glucose, GHbA(1C), and Homa IR between the two groups before and after CSII treatment. But the fasting plasma glucose was higher and Homa B was lower in group B than in group A before CSII treatment. The DeltaAUC (AUC after CSII subtracted from that before CSII) representing the recovery of beta-cell function was much greater in group A than in group B. The insulin dose of group B was significantly higher than that of the good glycemic control group. More severe hyperglycemia and relative beta-cell function deficiency may be the main reasons responsible for not achieving good glycemic control in newly diagnosed type 2 diabetic patients with short-term intensive CSII treatment.