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Abstract Context Although several studies suggest that improved β-cell function is a key determinant of glycemic remission in type 2 diabetes, other predictors remain unclear. Objective The aim of this clamp-based study was to identify predictors of 2-year glycemic remission after short-term intensive insulin treatment. Design A 2-year follow-up was planned in 124 drug-naïve type 2 diabetic patients who received continuous subcutaneous insulin infusion (CSII) for 2 weeks. Euglycemic-hyperinsulinemic clamps and intravenous glucose tolerance tests were performed to assess the insulin sensitivity (glucose infusion rate, GIR) and acute insulin response (AIR) pre- and post-CSII. Results First-phase insulin secretion was restored, and the GIR was significantly improved (P<0.0001) after the 2-week CSII. Glycemic remission rates were 47.6% and 30.7% after 12 and 24 months of follow-up, respectively. Cox analysis revealed that a higher post-CSII glucose level (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.15-1.66, P=0.0005) and older age at diabetes diagnosis (HR 1.34, 95% CI 1.05-1.72, P=0.02) accounted for an increased risk of hyperglycemic relapse. A 1-SD increase in the AIR (HR 0.75, 95% CI 0.57-0.99, P=0.04), GIR (HR 0.67, 95% CI 0.48-0.93, P=0.016) post-CSII, and baseline GIR (HR 0.71, 95% CI 0.51-0.99, P=0.047), were inversely associated with this risk. Conclusions Younger age at diabetes diagnosis, higher baseline insulin sensitivity and lower glucose levels after insulin treatment significantly favored a 2-year glycemic remission. This long-term remission was attributed to both improved insulin sensitivity and enhanced β-cell function after short-term intensive insulin treatment. Copyright © 2019 Endocrine Society
Journal of Clinical Endocrinology and Metabolism – Oxford University Press
Published: Jan 9, 2019
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