Elsevier

Metabolism

Volume 45, Issue 12, December 1996, Pages 1508-1513
Metabolism

Intensive therapy in adult insulin-dependent diabetes mellitus is associated with improved insulin sensitivity and reserve: A randomized, controlled, prospective study over 5 years in newly diagnosed patients

https://doi.org/10.1016/S0026-0495(96)90180-8Get rights and content

Abstract

Optimal blood glucose levels and normal insulin sensitivity are aims in the treatment of insulin-dependent diabetes mellitus (IDDM). Insulin sensitivity and insulin reserve are closely interrelated. It is essential to know more about both of these parameters at clinical diagnosis, because their preservation may delay the occurrence of diabetes-related complications. B-cell function is likely to be retained for a longer period in patients with adult onset of the disease compared with children. In this study, intensive insulin treatment was initiated in newly diagnosed adult patients to determine if it preserved endogenous insulin secretion longer than conventional therapy. Forty-nine patients with newly diagnosed diabetes were carefully categorized as having IDDM according to clinical and serological criteria. They were randomized to an intensive (I group) or conventional (C group) insulin therapy and evaluated for 5 years. Every 6 months, a check-up included glucagon-stimulated C-peptide (GSCP), hyperglycemic glucose clamp with arginine bolus, euglycemic-hyperinsulinemic clamp, and screening for microalbuminuda, retinopathy, and neuropathy. At the end of the study, hemoglobin A1c (HbA1c) was 6.3% ± 1.9% in the I patients and 8.1% ± 2.1 % in the C patients (P < .001). Blood glucose concentrations less than 3.5 mmol/L were more frequent in the I group than in the C group (P < .05). Insulin sensitivity (MI) and GSCP were higher in intensively treated patients after 5 years (MI, I group 40 ± 10 nmol · kg−1 · min−1 · pmol/L1 v C group 21 ± 11, P < .005; GSCP, I group 0.6 ± 0.2 nmol/L v C group 0.19 ± 0.11, P < .005). The prevalence of peripheral neuropathy was significantly lower in the I group at the end of the study. In conclusion, intensive therapy is more effective in the preservation of insulin action and reserve. In our patients, no case of severe hypoglycemia was observed, indicating that intensive therapy was safe in these patients.

References (32)

  • RJ Keller et al.

    Insulin prophylaxis in individuals at high risk of type 1 diabetes

    Lancet

    (1993)
  • L Nyström et al.

    Risk of developing insulin dependent diabetes mellitus (IDDM) before 35 years of age: Indications of climatological determinants for age at onset

    Int J Epidemiol

    (1992)
  • K Perlman et al.

    Sustained normoglycemia in newly diagnosed type-1 diabetic subjects: Short-term effect and one year follow-up

    Diabetes

    (1984)
  • SC Shah et al.

    A randomized trial of intensive insulin therapy in newly diagnosed insulin-dependent diabetes mellitus

    N Engl J Med

    (1989)
  • CR Stiller et al.

    Effects of cyclosporine immunosuppression in insulin dependent diabetes mellitus of recent onset

    Science

    (1984)
  • J Karjalainen et al.

    A comparison of childhood and adult type-1 diabetes mellitus

    N Engl J Med

    (1989)
  • T Linn et al.

    A one-year study of newly manifested type 1 diabetes mellitus under tight glucose control

    Med Welt

    (1994)
  • A Schiffrin et al.

    Factors predicting course of B-cell function in IDDM

    Diabetes Care

    (1992)
  • J Mirouze et al.

    Sustained insulin induced remissions of juvenile diabetes by means of an external artificial pancreas

    Diabetologia

    (1978)
  • S Madsbad et al.

    The transient effect of strict glycemic control on B-cell function in newly diagnosed type-1 (insulin-dependent) diabetic patients

    Diabetologia

    (1982)
  • H Yki-Järvinen et al.

    Insulin sensitivity in newly-diagnosed type-1 diabetics after ketoacidosis and after three months of insulin therapy

    J Clin Endocrinol Metab

    (1984)
  • P Reichard et al.

    Mortality and treatment side-effects during long-term intensified conventional insulin treatment in the Stockholm Diabetes Intervention Study

    Diabetes

    (1994)
  • The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus

    N Engl J Med

    (1993)
  • Diabetes mellitus

    WHO Tech Rep Ser

    (1985)
  • Consensus Statement
  • Diabetes Care and Research in Europe

    The Saint Vincent Declaration

    Diabetic Med

    (1990)
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