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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
 Sung Hee Choi  ;  Kyu Yeon Hur  ;  Dae Jung Kim  ;  Chul Woo Ahn  ;  Eun Seok Kang  ;  Bong Soo Cha  ;  Sung Kil Lim  ;  Kap Bum Huh  ;  Hyun Chul Lee 
Citation
 Clinical Endocrinology, Vol.69(4) : 549-555, 2008 
Journal Title
 Clinical Endocrinology 
ISSN
 0300-0664 
Issue Date
2008
MeSH
Aged ; Algorithms ; Blood Glucose/metabolism* ; Body Weights and Measures ; Clinical Protocols/standards ; Diabetes Mellitus, Type 2/blood ; Diabetes Mellitus, Type 2/metabolism ; Diabetes Mellitus, Type 2/physiopathology ; Diabetes Mellitus, Type 2/therapy* ; Fasting/blood ; Fasting/metabolism ; Female ; Glycated Hemoglobin A/analysis ; Humans ; Individuality ; Insulin Resistance/physiology* ; Insulin-Secreting Cells/physiology* ; Male ; Middle Aged
Keywords
Aged ; Algorithms ; Blood Glucose/metabolism* ; Body Weights and Measures ; Clinical Protocols/standards ; Diabetes Mellitus, Type 2/blood ; Diabetes Mellitus, Type 2/metabolism ; Diabetes Mellitus, Type 2/physiopathology ; Diabetes Mellitus, Type 2/therapy* ; Fasting/blood ; Fasting/metabolism ; Female ; Glycated Hemoglobin A/analysis ; Humans ; Individuality ; Insulin Resistance/physiology* ; Insulin-Secreting Cells/physiology* ; Male ; Middle 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.
Full Text
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2265.2008.03199.x/abstract
DOI
10.1111/j.1365-2265.2008.03199.x
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Eun Seok(강은석) ORCID logo https://orcid.org/0000-0002-0364-4675
Ahn, Chul Woo(안철우) ORCID logo https://orcid.org/0000-0003-3733-7486
Lee, Hyun Chul(이현철)
Lim, Sung Kil(임승길)
Cha, Bong Soo(차봉수) ORCID logo https://orcid.org/0000-0003-0542-2854
Hur, Kyu Yeon(허규연)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/106724
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