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Staged diabetes management according to individual patient insulin resistance and beta-cell function ameliorates glycaemic control in type 2 diabetes mellitus

Cited 3 time in Web of Science Cited 5 time in Scopus
Authors
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
2008-02-06
Publisher
Wiley-Blackwell
Citation
Clin Endocrinol (Oxf). 69(4), 549-555
Keywords
AgedAlgorithmsBlood Glucose/*metabolismBody Weights and MeasuresClinical Protocols/standardsDiabetes Mellitus, Type 2/blood/metabolism/physiopathology/*therapyFasting/blood/metabolismFemaleHemoglobin A, Glycosylated/analysisHumansIndividualityInsulin Resistance/*physiologyInsulin-Secreting Cells/*physiologyMaleMiddle Aged
Abstract
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.
ISSN
1365-2265 (Electronic)
Language
English
URI
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18248646

http://hdl.handle.net/10371/68178
DOI
https://doi.org/10.1111/j.1365-2265.2008.03199.x
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College of Medicine/School of Medicine (의과대학/대학원)Internal Medicine (내과학전공)Journal Papers (저널논문_내과학전공)
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