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Characteristics Predictive for a Successful Switch from Insulin Analogue Therapy to Oral Hypoglycemic Agents in Patients with Type 2 Diabetes

 Gyuri Kim  ;  Yong-ho Lee  ;  Eun Seok Kang  ;  Bong-Soo Cha  ;  Hyun Chul Lee  ;  Byung-Wan Lee 
 YONSEI MEDICAL JOURNAL, Vol.57(6) : 1395-1403, 2016 
Journal Title
Issue Date
Adult ; Blood Glucose/metabolism* ; C-Peptide ; Diabetes Mellitus, Type 2/drug therapy* ; Diabetes Mellitus, Type 2/metabolism ; Diabetes Mellitus, Type 2/physiopathology ; Drug Therapy, Combination ; Female ; Glycated Hemoglobin A/analysis ; Glycated Hemoglobin A/metabolism* ; Humans ; Hypoglycemic Agents/administration & dosage* ; Hypoglycemic Agents/therapeutic use ; Insulin/administration & dosage* ; Insulin/therapeutic use ; Male ; Middle Aged ; Postprandial Period
Hypoglycemic agents ; insulin ; type 2 diabetes mellitus
PURPOSE: The objective of this study was to investigate clinical and laboratory parameters that could predict which patients could maintain adequate glycemic control after switching from initial insulin therapy to oral hypoglycemic agents (OHAs) among patients with type 2 diabetes (T2D). MATERIALS AND METHODS: We recruited 275 patients with T2D who had been registered in 3 cohorts of initiated insulin therapy and followed up for 33 months. The participants were divided into 2 groups according to whether they switched from insulin to OHAs (Group I) or not (Group II), and Group I was further classified into 2 sub-groups: maintenance on OHAs (Group IA) or resumption of insulin (Group IB). RESULTS: Of 275 patients with insulin initiation, 63% switched to OHAs (Group I) and 37% continued insulin (Group II). Of these, 44% were in Group IA and 19% in Group IB. The lowest tertile of baseline postprandial C-peptide-to-glucose ratio (PCGR), higher insulin dose at switching to OHAs, and higher HbA1c level at 6 months after switching to OHAs were all associated with OHA failure (Group IB; p=0.001, 0.046, and 0.014, respectively). The lowest tertile of PCGR was associated with ultimate use of insulin (Group IB and Group II; p=0.029). CONCLUSION: Higher baseline level of PCGR and lower HbA1c levels at 6 months after switching to OHAs may be strong predictors for the successful maintenance of OHAs after switching from insulin therapy in Korean patients with T2D.
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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
Kim, Gyuri(김규리)
Lee, Byung Wan(이병완) ORCID logo https://orcid.org/0000-0002-9899-4992
Lee, Yong Ho(이용호) ORCID logo https://orcid.org/0000-0002-6219-4942
Cha, Bong Soo(차봉수) ORCID logo https://orcid.org/0000-0003-0542-2854
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