Influence of islet function on typing and prognosis of new-onset diabetes after intensive insulin therapy
Hui Fan, QingRong Pan, Pengrui Zhang, Jia Liu, Yuan Xu, Xinchun Yang
Beijing, China (mainland)
Med Sci Monit 2013; 19:787-793
It is difficult in clinical practice to differentiate patients with newly diagnosed diabetes and ketosis. The aim of this study was to investigate the effect of intensive insulin therapy on islet function in patients with new-onset diabetes and concomitant ketosis, and to determine the value of alternation in islet function in the typing of diabetes.
Material and Methods: A total of 206 inpatients with new-onset diabetes and ketosis were recruited after intensive insulin therapy and followed for 36 months. Patients were divided into type 1 diabetes group (Group A) and type 2 diabetes group (Group B). Islet function was compared between the 2 groups before and after intensive insulin therapy, and the influence of islet function on the typing of diabetes and the selection of therapeutic strategies is discussed.
Results: In group A, the AUCI, AUCC, HOMA-â cell and HOMA-IR were significantly lower than those in Group B before and after intensive insulin therapy. The sensitivity and accuracy of antibody test were at a low level in Group A. An insulin release test was done after intensive insulin therapy. Results showed that the peaks of insulin and C peptide appeared at 0.5–1 h after glucose administration in Group A, which was earlier than that before therapy, but the maximal levels were no more than 2 times those of baseline levels. In Group B, the peaks appeared at 2 h, and the maximal levels were about 10 times those of baseline levels.
Conclusions: Poor islet function, incomplete recovery of islet function after intensive insulin therapy, and a short “honeymoon” period are characteristics of type 1 diabetes. Detection of diabetes-related antibodies is not reliable.
Keywords: Adult, Adolescent, Alanine Transaminase - blood, Antibodies - blood, Area Under Curve, Aspartate Aminotransferases - blood, Body Mass Index, Diabetes Mellitus, Type 1 - drug therapy, Diabetes Mellitus, Type 2 - drug therapy, Diagnosis, Differential, Enzyme-Linked Immunosorbent Assay, Glucose, Insulin - therapeutic use, Insulin Resistance - physiology, Islets of Langerhans - physiology, Models, Biological, Sensitivity and Specificity, Time Factors