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Effects of insulin therapy on non-insulin-dependent diabetics with secondary oral hypoglycemic agent failure
1Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C.
Background:
To search for the mechanisms of secondary oral hypoglycemic agent (OHA) failure in non-insulin-dependent diabetic (NIDD) and to identify the effects of insulin therapy on these patients, we observed their pancreatic beta-cell function and metabolic parameters.
Materials And Methods:
The clinical characteristics and C-peptide responses to glucagon were analyzed in 37 NIDD with secondary OHA failure. All patients received insulin therapy and we measured their fasting plasma glucose (FPG), body mass index (BMI) and glycohemoglobin (HbA1C) levels at 3 months, their serum triglyceride and cholesterol levels at 6-12 months and performed glucagon tests at 0.5-29 months.
Results:
Poor beta-cell function was observed in 11 (29.7%) patients (Group A) and fair beta-cell function in 26 (70.3%) patients (Group B). The mean age at diagnosis, the number of years since diagnosis of diabetes, FPG levels and HbA1C levels were similar in both groups. However, the patients in Group A had a lower average BMI (18.9 +/- 0.7 vs 22.1 +/- 0.6 kg/m2, p = 0.006) than those of Group B. After insulin therapy, the FPG levels (215 +/- 14 vs 282 +/- 12 mg/dL, p < 0.001) and HbA1C levels 9.2 +/- 0.5 vs 11.6 +/- 0.5%, p < 0.001) of both groups decreased but the BMI (23.1 +/- 0.7 vs 21.6 +/- 0.7 kg/m2, p < 0.001) increased significantly. However, the blood lipid levels and beta-cell function did not change. The beta-cell function was still poor in 5 out of 6 patients in Group A, but it was unchanged in all patients in Group B.
Conclusion:
About 1/3 of NIDD with secondary OHA failure are permanently insulin deficient and need long-term insulin treatment.
Insights
Approximately one-third of patients with non-insulin-dependent diabetes (NIDD) experience secondary oral hypoglycemic agent (OHA) failure and require insulin therapy due to permanent insulin deficiency. This study investigated their pancreatic beta-cell function and metabolic changes.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Diabetes Mellitus Research
Background:
- Secondary failure to oral hypoglycemic agents (OHA) is common in non-insulin-dependent diabetes (NIDD).
- Understanding the mechanisms of OHA failure and the impact of insulin therapy is crucial for effective diabetes management.
Purpose of the Study:
- To investigate the mechanisms of secondary OHA failure in NIDD patients.
- To evaluate the effects of insulin therapy on pancreatic beta-cell function and metabolic parameters in these patients.
Main Methods:
- Analysis of clinical characteristics and C-peptide responses to glucagon in 37 NIDD patients with secondary OHA failure.
- Monitoring of fasting plasma glucose (FPG), body mass index (BMI), and glycohemoglobin (HbA1C) levels.
- Assessment of serum triglyceride and cholesterol levels and glucagon stimulation tests over time.
Main Results:
- Patients were categorized into Group A (poor beta-cell function, 29.7%) and Group B (fair beta-cell function, 70.3%).
- Insulin therapy significantly reduced FPG and HbA1C levels and increased BMI in both groups.
- Beta-cell function remained poor in most Group A patients after insulin therapy, while it was unchanged in Group B.
Conclusions:
- A significant proportion (about 1/3) of NIDD patients with secondary OHA failure exhibit permanent insulin deficiency.
- These patients necessitate long-term insulin treatment for optimal glycemic control.