Lower mean blood glucose during short‐term intensive insulin therapy is associated with long‐term glycemic remission in patients with newly diagnosed type 2 diabetes: Evidence‐based recommendations for standardization

Abstract

Aims/IntroductionOptimal glycemic targets during short‐term intensive insulin therapy in patients with newly diagnosed type 2 diabetes are not standardized. The present study was carried out to determine the optimal glycemic targets during therapy by analyzing the impacts of glucose levels on therapeutic outcomes.Materials and MethodsA total of 95 individuals with newly diagnosed type 2 diabetes were enrolled. Short‐term intensive insulin therapy was carried out using an insulin pump to achieve and maintain glycemic targets (fasting blood glucose ≤6.0 mmol/L, 2‐h postprandial blood glucose ≤7.8 mmol/L) for 14 days, with daily eight‐point capillary blood glucose profiles recorded. Patients were followed up for 1 year after discharge.ResultsIn most participants, the mean blood glucose and glycemic excursion parameters during the therapy were controlled within the normal range. Mean blood glucose was independently associated with amelioration of acute insulin response (r = −0.25, P = 0.015) and 1‐year remission (odds ratio 0.12, 95% confidence interval 0.034–0.426), but negatively associated with more level 1 hypoglycemia (r = −0.34, P = 0.001), although major hypoglycemia was rare. Among mean blood glucose tertiles, patients in the middle (68.7%) and lower (75.0%) tertiles had a higher 1‐year remission rate compared with the upper tertile (32.3%, both P < 0.001), whereas only the middle tertile did not have increased hypoglycemia compared with the upper tertile (8.1 ± 5.4 vs 7.2 ± 3.9 events/person, P = 0.48).ConclusionsStricter glycemic control during short‐term intensive insulin therapy produced more remission despite self‐manageable hypoglycemia. Based on glycemic parameters in the middle mean tertile, we propose new glycemic targets that are approximately 0.4 mmol/L lower than current the targets, as long‐term benefit outweighs short‐term risks.

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

“…Whereas in our previous study, we did not found differences of hypoglycemia between patients in the remission group and those in the nonremission group [23]. The reason was that in our previous studies, hypoglycemia was not analyzed by subgroups.…”

Insulin Pump Therapy for Patients With Type 2 Diabetes Mellitus: Evidence, Current Barriers, and New Technologies

“…42 In other trials, a run-in period before starting CSII was performed as well; however, the duration of such periods was highly variable. 16,26,29,41,49,53 In most trials initiating CSII, a basal insulin delivery of 40%-60% of the total daily insulin dose was chosen. 26,27,29,47,56 In some studies, patients stopped previous antidiabetic therapy options when CSII therapy was initiated, 31,33,40,52 whereas others used previous therapy options like oral antidiabetic drugs additionally.…”

Practical application of short-term intensive insulin therapy based on the concept of “treat to target” to reduce hypoglycaemia in routine clinical site

“…Short-term (two to four week) intensive insulin therapy (SIIT) administered early in the course of T2DM acutely improves beta cell function by eliminating glucotoxicity, lipo-toxicity and insulin resistance [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] . Long-term intensive insulin therapy (LIIT) was used to compensate defective insulin to make physiological form of insulin secretion in the irreversible component of beta cell death.…”

“…Indeed, it is possible that stepwise addition of insulin leads to the reduction of hyperglucagonaemia.The evidence of this treatment has been presented to prove benefits in the treatment of T2DM. However, in most SIIT studies, after SIIT they did not use any anti-diabetic agents and evaluated the duration of glycaemic remission [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] . As the results, glycaemic remission was temporary, especially when beta-cell function was markedly deteriorated after SIIT.…”