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

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 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). 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.