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

Sung Hee Choi, Kyu Yeon Hur, Dae Jung Kim, Chul Woo Ahn, Eun Seok Kang, Bong Soo Cha, Sungkil Lim, Kap Bum Huh, Hyun Chul Lee

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Abstract

Objective: The current consensus algorithm for management of type 2 diabetes is based on the fasting glucose concentration and glycated haemoglobin A1c (HbA1c) 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 enrolment. 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). HbA1c level decreased from 8.37 ± 1.42% to 7.72 ± 1.39% (P < 0.001). About 43% of the new SDM group achieved an HbA1c 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.

Original languageEnglish
Pages (from-to)549-555
Number of pages7
JournalClinical Endocrinology
Volume69
Issue number4
DOIs
Publication statusPublished - 2008 Oct 1

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Type 2 Diabetes Mellitus
Insulin Resistance
Insulin
Glucose
Fasting
Hemoglobins
C-Peptide
Glycosylated Hemoglobin A
Consensus
Therapeutics
Serum

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Choi, Sung Hee ; Hur, Kyu Yeon ; Kim, Dae Jung ; Ahn, Chul Woo ; Kang, Eun Seok ; Cha, Bong Soo ; Lim, Sungkil ; Huh, Kap Bum ; Lee, Hyun Chul. / Staged diabetes management according to individual patient insulin resistance and β-cell function ameliorates glycaemic control in type 2 diabetes mellitus. In: Clinical Endocrinology. 2008 ; Vol. 69, No. 4. pp. 549-555.
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abstract = "Objective: The current consensus algorithm for management of type 2 diabetes is based on the fasting glucose concentration and glycated haemoglobin A1c (HbA1c) 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 enrolment. 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). HbA1c level decreased from 8.37 ± 1.42{\%} to 7.72 ± 1.39{\%} (P < 0.001). About 43{\%} of the new SDM group achieved an HbA1c 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.",
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Staged diabetes management according to individual patient insulin resistance and β-cell function ameliorates glycaemic control in type 2 diabetes mellitus. / Choi, Sung Hee; Hur, Kyu Yeon; Kim, Dae Jung; Ahn, Chul Woo; Kang, Eun Seok; Cha, Bong Soo; Lim, Sungkil; Huh, Kap Bum; Lee, Hyun Chul.

In: Clinical Endocrinology, Vol. 69, No. 4, 01.10.2008, p. 549-555.

Research output: Contribution to journalArticle

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AU - Choi, Sung Hee

AU - Hur, Kyu Yeon

AU - Kim, Dae Jung

AU - Ahn, Chul Woo

AU - Kang, Eun Seok

AU - Cha, Bong Soo

AU - Lim, Sungkil

AU - Huh, Kap Bum

AU - Lee, Hyun Chul

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N2 - Objective: The current consensus algorithm for management of type 2 diabetes is based on the fasting glucose concentration and glycated haemoglobin A1c (HbA1c) 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 enrolment. 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). HbA1c level decreased from 8.37 ± 1.42% to 7.72 ± 1.39% (P < 0.001). About 43% of the new SDM group achieved an HbA1c 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.

AB - Objective: The current consensus algorithm for management of type 2 diabetes is based on the fasting glucose concentration and glycated haemoglobin A1c (HbA1c) 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 enrolment. 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). HbA1c level decreased from 8.37 ± 1.42% to 7.72 ± 1.39% (P < 0.001). About 43% of the new SDM group achieved an HbA1c 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.

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