The One-year Efficacy After Short-term Insulin Pump Treatment In Newly Diagnosed Type 2 Diabetes

Objective: Diabetes mellitus (DM) is a heterogeneous group of metabolic diseases characterized by chronic hyperglycemia, accompanied by carbohydrate, fat and protein metabolic abnormality. 90% to 95% are type 2 diabetes mellitus (T2DM) . In the past, we thought theβ-cell function of newly diagnosed T2DM only decreased by 50%, but in fact, it may reach by 90%, for positive measures were not taken. For this revelation, the treatment target for newly diagnosed T2DM should be different from those with long duration, whose glycemic control is to prevent further deterioration of complications. For newly diagnosed T2DM, the restoration and protection ofβcell function may be more important. A large number of studies have confirmed that, for short-term therapeutic effect(<6 months),early short-term insulin pump treatment enables hyperglycemia quickly reach normal or near-normal level in newly diagnosed T2DM patients, which eliminating high glucose toxicity, improvingβcell function and reducing insulin resistance. However, there are few studies for long-term efficacy observation (1 year later). In this study, we research the long-term (1 year later) efficacy, safety and the effects onβcell function and insulin sensitivity after short-term intensive insulin pump therapy in newly diagnosed patients with T2DM, in order to provide a more favorable evidence for insulin pump therapy in newly diagnosed T2DM.Methods: According to the diagnostic and classification criteria recommended by the World Health Organization (WHO) in 1999, thirty-two newly diagnosed T2DM patients in our hospital were selected in our study, with fasting plasma glucose (FPG)≥11.1mmol / L, and (or) glycosylated hemoglobin (HbA1c)≥9%, have not received any OHAs before, no severe acute or chronic diabetic complications or severe complications in heart, liver, etc. On the first day of admission, height and weight were measured to calculate body mass index (BMI), fasting plasma glucose (FPG), glycosylated hemoglobin A1c (HbA1c) and postprandial 2 hour blood glucose (2hPBG) after three meals were determined, mean 2hPBG was calculated. When blood glucose decreased stably (CSII therapy for about 1 week), we measured FPG, 2hPBG, fasting C peptide (FCP) and OGTT 2-hour C peptide (2hCP). We used homeostasis model assessment formula to calculate HOMA-IR (homeostasis model assessment-insulin resistance) and HOMA-β(homeostasis model assessment-pancreaticβcell). After admission, the continuous subcutaneous insulin infusion (CSII) therapy was carried out for 2 weeks, and the dosage of insulin was recorded. After discharge, according toβcell function and insulin dosage, the patients were divided into subcutaneous insulin injection group (Ins group), including 11 patients; oral hypoglycemic agents group (OHA group), including 13 patients and only lifestyle intervention group (no drug group) ,including 8 patients. Each of them was treated for three months. The above indicators were re-checked 1 year later. The self-comparison between before and after treatment was implemented for all the patients. According to the indicators re-checked 1 year later, the comparison among the patients of each group and the statistical analysis were implemented, and the patients'final outcomes of the three groups were recorded.Results:1. There is no significant difference (P> 0.05) in all patients'gender, age, BMI, FPG, 2hPBG, HbA1c, FCP, 2hCP, HOMA-IR and HOMA-β, which are comparable. During the two weeks of CSII treatment, the difference in insulin dosage among the three groups of patients is statistically significant (P <0.05).2. All patients'FPG, 2hPBG and HbA1c and HOMA-IR after treatment were significantly decreased compared with those before treatment (P <0.05); the FCP, 2hCP and HOMA-βafter treatment were significantly higher than those before treatment (P<0.05), the difference was statistically significant.3. The final outcome of the three groups one year later: in Ins group, 8 patients changed to OHA treatment and 3 patients changed to only lifestyle intervention; in OHA group, 6 patients continued OHA application and 7 patients changed to lifestyle intervention; the no drug group continued lifestyle intervention. Therefore, the final outcome is that 14 patients (43.75%) belong to OHA group and 18 patients (56.25%) belong to only lifestyle intervention group.4. One-year outcome shows that there is no statistical difference in the mean values of 2hPBG, HbA1c, FCP, 2hCP, HOMA-βand HOMA-IR among the three groups (P> 0.05). Conclusion:1. For newly diagnosed T2DM patients, short-term CSII treatment can effectively induce good glycemic control even one-year's later, and significantly improveβcell function and insulin sensitivity;2. Early CSII treatment in newly diagnosed T2DM patients let more than a half patients achieve complete remission with drug withdrawal within one year after treatment;3. Early CSII treatment in newly diagnosed T2DM can achieve good therapeutic effect through individualized treatment according to the conditions of insulin dosage and islet function.