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Beta-cell function evaluated by HOMA as a predictor of secondary sulphonylurea failure in Type 2 diabetes
M J Taverna1, N Pacher, F Bruzzo
1Department of Diabetology, INSERM U. 341, Paris, France.
Background And Aims:
Secondary failure to oral hypoglycaemic agents, a common evolution of long-standing Type 2 diabetes, is usually assessed by non-standardized indices requiring fine clinical assessment, including hyperglycaemia resistant to maximum doses of sulphonylureas despite appropriate diet and follow-up. The goal of this study was to evaluate if HOMA, a modelized plasma insulin/glucose ratio allowing simple evaluation of residual insulin secretion and sensitivity, is a better predictor of the insulin requiring stage than clinical indices.
Materials And Methods:
HOMA was measured in 84 Type 2 diabetic patients aged 58 +/- SD 6 years, with diabetes duration 11 +/- 4 years, hospitalized because of hyperglycaemia resistant to maximal doses of sulphonylureas (e.g. glibenclamide > or = 15 mg/day), with no apparent external reason for hyperglycaemia. Despite reinforced appropriate diet recommendations, 62 of these patients remained hyperglycaemic (insulin-requiring group).
Results:
Age, duration of diabetes, body mass index (BMI) and HOMA value for insulin sensitivity (71 +/- 6% vs. 76 +/- 7%, normal values 59-161%) were comparable in the two groups. HbA(1c) was higher (10.0 +/- 0.2% vs. 8.3 +/- 0.3%, P < 0.001) and HOMA insulin secretion values lower (25 +/- 2% vs. 43 +/- 6%, normal values 70-150%, P < 0.01) in the insulin-requiring group. Of the following potential predictors: HbA(1c) > 8%, duration of diabetes > or = 10 years, HbA(1c) combined with diabetes duration, insulin sensitivity < or = 40%, insulin secretion < or = 20%, the latter showed the best positive predictivity (86% patients with low insulin secretion were insulin-requiring).
Conclusions:
(i) HOMA is a simple and good predictor of the insulin-requiring stage in Type 2 diabetes mellitus; (ii) this stage of diabetes is characterized by a further decline of insulin secretion rather than of insulin sensitivity. Diabet. Med. 18, 584-588 (2001)
Insights
Homeostatic model assessment (HOMA) effectively predicts the need for insulin in Type 2 diabetes patients. This method is superior to clinical indices for identifying patients progressing to insulin therapy.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Diabetes Mellitus Research
Background:
- Secondary failure to oral hypoglycaemic agents is common in long-standing Type 2 diabetes.
- Current assessment relies on non-standardized clinical indices.
- Predicting the transition to insulin therapy requires improved methods.
Purpose of the Study:
- To evaluate Homeostatic Model Assessment (HOMA) as a predictor of insulin requirement in Type 2 diabetes.
- To compare HOMA's predictive value against traditional clinical indices.
- To identify key markers for the insulin-requiring stage of diabetes.
Main Methods:
- HOMA was measured in 84 Type 2 diabetic patients with hyperglycaemia resistant to oral agents.
- Patients were assessed for insulin secretion and sensitivity using HOMA.
- A subset of 62 patients required insulin therapy despite dietary interventions.
Main Results:
- Lower HOMA values for insulin secretion (25% vs 43%) were observed in the insulin-requiring group.
- Higher HbA1c levels (10.0% vs 8.3%) were also noted in patients needing insulin.
- Insulin secretion < 20% demonstrated the highest positive predictivity (86%) for insulin requirement.
Conclusions:
- HOMA is a simple and effective predictor for identifying Type 2 diabetes patients progressing to insulin therapy.
- The insulin-requiring stage is primarily characterized by a decline in insulin secretion, not insulin sensitivity.
- HOMA offers a valuable tool for clinical assessment in managing Type 2 diabetes progression.