S-Space College of Medicine/School of Medicine (의과대학/대학원) Internal Medicine (내과학전공) Journal Papers (저널논문_내과학전공)
Staged diabetes management according to individual patient insulin resistance and beta-cell function ameliorates glycaemic control in type 2 diabetes mellitus
- Choi, Sung Hee; Hur, Kyu Yeon; Kim, Dae Jung; Ahn, Chul Woo; Kang, Eun Seok; Cha, Bong Soo; Lim, Sung Kil; Huh, Kap Bum; Lee, Hyun Chul
- Issue Date
- Clin Endocrinol (Oxf). 69(4), 549-555
- Aged; Algorithms; Blood Glucose/*metabolism; Body Weights and Measures; Clinical Protocols/standards; Diabetes Mellitus, Type 2/blood/metabolism/physiopathology/*therapy; Fasting/blood/metabolism; Female; Hemoglobin A, Glycosylated/analysis; Humans; Individuality; Insulin Resistance/*physiology; Insulin-Secreting Cells/*physiology; Male; Middle Aged
- OBJECTIVE: The current consensus algorithm for management of type 2 diabetes is based on the fasting glucose concentration and glycated haemoglobin A(1c) (HbA(1c)) level. We applied a new therapeutic strategy by assessing insulin secretion and insulin resistance, in addition to glucose concentrations in individual patients. DESIGN AND PATIENTS: We enrolled 193 patients with type 2 diabetes. The patients were assigned to one of six groups according to insulin secretion measured by the serum fasting C-peptide concentration and insulin resistance measured by an insulin tolerance test (ITT). The two groups were treated differently: 108 patients were treated using a new staged diabetes management (SDM) strategy and 85 patients continued with conventional therapy. MEASUREMENTS: We compared metabolic variables in the two groups at baseline and 12 months after enrollment. RESULTS: In patients treated with the SDM strategy, fasting glucose concentration decreased from 9.8 +/- 2.1 to 8.2 +/- 1.7 mmol/l (P < 0.001). Postprandial 2-h glucose concentration decreased from 14.19 +/- 3.34 to 12.27 +/- 3.24 mmol/l (P < 0.001). HbA(1c) level decreased from 8.37 +/- 1.42% to 7.72 +/- 1.39% (P < 0.001). About 43% of the new SDM group achieved an HbA(1c) of < 7.0% compared with 25% of patients in the conventional treatment group. CONCLUSIONS: The new SDM strategy, based on individual data on insulin resistance and insulin secretion, may provide valuable clinical benefits in non-obese Korean patients with type 2 diabetes.
- 1365-2265 (Electronic)
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