Insulin as an Early Treatment for Type 2 Diabetes

Prato, Stefano Del; Bianchi, Cristina; Dardano, Angela; Miccoli, Roberto

doi:10.2337/dcs13-2019

Cited by 5 publications

(2 citation statements)

References 37 publications

(49 reference statements)

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“…However, the question whether early treatment with insulin 28 , 29 , 30 can really provide β-cell protection, is not clearly established and requires long-term clinical studies. As pointed out by Del Prato and coauthors [31] , any treatment capable of correcting the pathogenetic β-cell abnormalities should ensure glycemic stability. In this context, the proposal by DeFronzo et al.…”

Section: Discussionmentioning

confidence: 99%

Declining ß-cell function is associated with the lack of long-range negative correlation in glucose dynamics and increased glycemic variability: A retrospective analysis in patients with type 2 diabetes

Kohnert

Heinke

Vogt³

et al. 2014

Journal of Clinical & Translational Endocrinology

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ObjectiveTo determine whether characteristics of glucose dynamics are reflections of β-cell function or rather of inadequate diabetes control.Materials/methodsWe analyzed historical liquid meal tolerance test (LMTT) and continuous glucose monitoring (CGM) data, which had been obtained from 56 non-insulin treated type 2 diabetic outpatients during withdrawal of antidiabetic drugs. Computed CGM parameters included detrended fluctuation analysis (DFA)-based indices, autocorrelation function exponent, mean amplitude of glycemic excursions (MAGE), glucose SD, and measures of glycemic exposure. The LMTT-based disposition index (LMTT-DI) calculated from the ratio of the area-under-the-insulin-curve to the area-under-the-glucose-curve and Matsuda index was used to assess relationships among β-cell function, glucose profile complexity, autocorrelation function, and glycemic variability.ResultsThe LMTT-DI was inverse linearly correlated with the short-range α1 and long-range scaling exponent α2 (r = −0.275 and −0.441, respectively, p < 0.01) such that lower glucose complexity was associated with better preserved insulin reserve, but it did not correlate with the autocorrelation decay exponent γ. By contrast, the LMTT-DI was strongly correlated with MAGE and SD (r = 0.625 and 0.646, both p < 0.001), demonstrating a curvilinear relationship between β-cell function and glycemic variability. On stepwise regression analyses, the LMTT-DI emerged as an independent contributor, explaining 20, 38, and 47% (all p < 0.001) of the variance in the long-range DFA scaling exponent, MAGE, and hemoglobin A1C, respectively, whereas insulin sensitivity failed to contribute independently.ConclusionsLoss of complexity and increased variability in glucose profiles are associated with declining β-cell reserve and worsening glycemic control.

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Section: Discussionmentioning

confidence: 99%

Declining ß-cell function is associated with the lack of long-range negative correlation in glucose dynamics and increased glycemic variability: A retrospective analysis in patients with type 2 diabetes

Kohnert

Heinke

Vogt³

et al. 2014

Journal of Clinical & Translational Endocrinology

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“…This condition, together with impaired phosphatidylinositol 3-kinase activation of nitric oxide synthase, could lead to an atherogenic state [15].…”

Section: Antidiabetic Therapies and Cvdmentioning

confidence: 99%