The Effect Of Short-term Intensive Insulin Therapy On Type 2 Diabetes Mellitus Patients At Different Phase

Background and ObjectivesThe beta-cell function has decreased by 50%when the patient is diagnosed as type 2 diabetes mellitus(T2DM).The dysfunction continues to decline linearly with the progress of disease.Glucotoxicity is not only the result of beta-cell dysfunction, but also contributes to the dysfunction.lipotoxicity and oxidative stress in collaborate with glucotoxicity are also involved in the dysfunction.In the traditional therapy of T2DM,firstly we start to lifestyle interventions, such as diet and physical exercises.Oral hypoglycemic agents are added in our therapies when we fail to acquire satisfactory glycemic control.we have to fall back on insulin therapy finally.But the blood glycose have not been controlled satisfiedly as the large clinical trial showing.Many reports have shown that short term inensive insulin therapy could improve (3-cell function and insulin resistance in newly diagnosed severe type 2 diabetes.The treatment also could induce prolonged ideal glycemic control.AS a result, we should adjust our traditional treatment and remark the use and status of insulin.The study is designed to observe the influence of short term intensive insulin therapy on theβ-cell function and compare the difference of time achieving excellent blood glucose control, the daily dose of insulin in the type 2 diabetes of newly diagnosed and with secondary sulfonylureas failure and try to explain the mechanism.Research subjects and methodsWe collected randomly 25 cases with newly diagnosed type 2 diabetes who had not received antihyperglycaemic therapy and 20 cases type 2 diabetes with secondary sulfonylureas failure who were enrolled into the sceond cinical college of Zhengzhou University from 2008 March to 2010 March.All the patients accepted the intensive insulin therapy to achieve the glycaemic goal that was defined as fasting blood glucose was less than 6.1mmol/L and 2h post-prandially blood glucose was less than 8.0mmol/L.The insulin dose was altered according to the blood glucose. The intensive insulin therapy was ended after nonnoglycemia was maintained for two days.Before and after the treatment, FBG,2hPG, TG, TC, LDL-C, HDL-C,ΔC30/ΔG30, HOMA-βand HOMA-IR were measured.we also observed the difference of the time achieving excellent blood glucose control and the daily dose of insulin.The data evaluation was handled with SPSS 10.0 program and the data were expressed by mean±tandard deviation.The difference of one group before and after treatment was analyzed with paired t-test.The assessment of differences between groups was analyzed with independent t-test. Statistical significance was defined as P<0.05.ResultsAll the recruited patients amount to forty-five cases.The basic parameters were of no differences in group A and B.After treatment, both group A and group B had improved significantly at FBG, 2hPG, TG, LDL-C, HDL-C,ΔC30/ΔG30,HOMA-p and HOMA-IR.The improvement of FBG,2hPG, TG, LDL-C, HDL-C,ΔC30/ΔG30 and HOMA-βwere more obvious in group A (P=0.043, P=0.036, P=0.047, P=0.03, P=0.04, P=0.048, P=0.007).As far as TC and HOMA-IR were concerned, there was not significant difference in two groups before and after treatment (P=0.404, P=0.339).The time achieving normoglycemia of group A were less than group B.The difference was of statistical significance. (P=0.008)There was not statistical difference in the daily dose of insulin of the two groups (P=0.190)ConclusionThe short-term intensive insulin therapy can improve signifcantly the glucose/lipid metabolism and theβ-cell function of type 2 diabetes.The benefit was more dominant in the newly diagnosed type 2 diabetes.