Insulina Efecto Sobre Cel Beta En Dm 2 Recien Diagnosticada

Clinical Care/Education/Nutrition/Psychosocial Research
ORIGINAL

ARTICLE

Beneficial Effects of Insulin on Glycemic
Control and -Cell Function in Newly
Diagnosed Type 2 Diabetes With Severe
Hyperglycemia After Short-Term Intensive
Insulin Therapy
HARN-SHEN CHEN, MD, PHD1,2,3
TZU-EN WU, MD3
TJIN-SHING JAP, MD2,3

LI-CHUAN HSIAO, BSC1
SHEN-HUNG LEE, BSC1
HONG-DA LIN, MD1,2,3OBJECTIVE — To evaluate whether treatment with insulin is advantageous compared with
oral antidiabetes agents in newly diagnosed type 2 diabetes with severe hyperglycemia after
short-term intensive insulin therapy.
RESEARCH DESIGN AND METHODS — Newly diagnosed type 2 diabetic patients
with severe hyperglycemia were hospitalized and treated with intensive insulin injections for
10 –14 days. Theoral glucose tolerance test (OGTT) was performed after intensive insulin
treatment. After discharge, the patients were randomized to receive either insulin injections or
oral antidiabetes drugs (OADs) for further management. The OGTT was repeated 6 months later,
and -cell function and insulin sensitivity were evaluated again. These subjects were continually
followed up for another 6 months toevaluate their long-term glycemic control.
RESULTS — At the 6th month of the study, the A1C level was significantly lower in the insulin
group than in the OAD group (6.33
0.70% vs. 7.50
1.50%; P
0.002). During the
follow-up visit, the A1C level was still better in the insulin group (6.78 1.21% vs. 7.84
1.74%; P
0.009). All parameters regarding -cell function measured in the OGTT wereimproved significantly in both groups after 6 months of treatment. Compared with the OAD
group, the homeostasis model assessment of -cell function index, insulin area under the curve,
and insulinogenic index were better in the insulin group.
CONCLUSIONS — A 6-month course of insulin therapy, compared with OAD treatment,
could more effectively achieve adequate glycemic control and significantimprovement of -cell
function in new-onset type 2 diabetic patients with severe hyperglycemia.
Diabetes Care 31:1927–1932, 2008

I

nsulin resistance and impaired insulin
secretion are the main pathophysiological defects responsible for the development of hyperglycemia in type 2 diabetes
(1,2). With the continuous presence of insulin resistance, progressive loss of -cell
function is the crucialdefect. The continuous decline in -cell function is affected by

glucotoxicity generated by hyperglycemia
and lipotoxicity due to lipolysis (3). Impaired -cell function appears to be reversible, particularly in the early stage of the
disease, when the limiting threshold for reversibility of decreased -cell mass has
probably not been passed (4). So the potential benefits of early, aggressiveintervention

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From the 1Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General
Hospital, Taipei, Taiwan; the 2Section of Biochemistry, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; and the 3National Yang-Ming University School of
Medicine, Taipei, Taiwan.Corresponding author: Hong-Da Lin, chenhs@vghtpe.gov.tw.
Received 15 January 2008 and accepted 3 June 2008.
Published ahead of print at http://care.diabetesjournals.org on 12 June 2008. DOI: 10.2337/dc08-0075.
Clinical trial reg. no. NCT00506194, clinicaltrials.gov.
© 2008 by the American Diabetes Association. Readers may use this article as long as the work is properly
cited, the use iseducational and not for profit, and the work is not altered. See http://creativecommons.
org/licenses/by-nc-nd/3.0/ for details.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby
marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

See accompanying editorial, p. 2070...