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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.

Authors
Choi, SH; Hur, KY; Kim, DJ; Ahn, CW; Kang, ES; Cha, BS; Lim, SK; Huh, KB; Lee, HC
Citation
Clinical endocrinology, 69(4):549-555, 2008
Journal Title
Clinical endocrinology
ISSN
0300-06641365-2265
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.
MeSH terms
AgedAlgorithmsBlood Glucose/metabolism*Body Weights and MeasuresClinical Protocols/standardsDiabetes Mellitus, Type 2/bloodDiabetes Mellitus, Type 2/metabolismDiabetes Mellitus, Type 2/physiopathologyDiabetes Mellitus, Type 2/therapy*Fasting/bloodFasting/metabolismFemaleHemoglobin A, Glycosylated/analysisHumansIndividualityInsulin Resistance/physiology*Insulin-Secreting Cells/physiology*MaleMiddle Aged
DOI
10.1111/j.1365-2265.2008.03199.x
PMID
18248646
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Endocrinology & Metabolism
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