Department of Diabetes and Metabolic Medicine, International Medical Center of Japan, Toyama Hospital, Tokyo, Japan.
Endocr J. 2010;57(3):237-44. doi: 10.1507/endocrj.k09e-279. Epub 2009 Dec 23.
Insulin therapy represents the most effective and reliable means of achieving satisfactory glycemic control. However, few studies have evaluated the predictors of future insulin use. The purpose of this study was to investigate the predictors of future insulin use in type 2 diabetic patients. In this study, we conducted a chart review of 158 Japanese type 2 diabetic patients admitted to our hospital for stringent glycemic control. Of the 158 subjects, 92 satisfied the inclusion criteria for this study. We assessed the associations between baseline BMI, fasting plasma glucose levels (FPG) and serum and urinary C-peptide levels (sCPR and uCPR), and insulin usage at 6 months after discharge. We also computed the areas under the curve (AUCs) in receiver operator characteristic (ROC) curves for each predictor to predict the future insulin use. After adjustment for gender, age, and BMI, the multivariable odds ratios (ORs) for future insulin use in the highest tertile as compared with lowest tertile were 0.12 for BMI (95% confidence interval (CI), 0.03-0.52), 17.0 for FPG (95% CI, 3.27-88.7), 0.12 for sCPR (95% CI, 0.02-0.71), and 0.03 for uCPR (95% CI, 0.00-0.24). Prediction analyses showed that the AUCs for BMI, FPG, sCPR, and uCPR were 0.73, 0.76, 0.74, and 0.78, respectively, which suggests that the predictive abilities of these predictors do not differ substantially. In conclusion, this study suggests that BMI, FPG, sCPR, and uCPR are strong predictors of the future insulin use in type 2 diabetic patients.
胰岛素治疗是实现满意血糖控制的最有效和可靠手段。然而，很少有研究评估未来胰岛素使用的预测因素。本研究旨在探讨 2 型糖尿病患者未来胰岛素使用的预测因素。在这项研究中，我们对 158 名因严格血糖控制而住院的日本 2 型糖尿病患者进行了病历回顾。在 158 名受试者中，有 92 名符合本研究的纳入标准。我们评估了基线 BMI、空腹血糖水平（FPG）以及血清和尿 C 肽水平（sCPR 和 uCPR）与出院后 6 个月胰岛素使用之间的关系。我们还计算了每个预测因素在受试者工作特征（ROC）曲线下的曲线下面积（AUC），以预测未来的胰岛素使用。在校正性别、年龄和 BMI 后，最高三分位组与最低三分位组相比，未来胰岛素使用的多变量优势比（OR）分别为 BMI（95%置信区间（CI），0.03-0.52）0.12、FPG（95%CI，3.27-88.7）17.0、sCPR（95%CI，0.02-0.71）0.12 和 uCPR（95%CI，0.00-0.24）0.03。预测分析表明，BMI、FPG、sCPR 和 uCPR 的 AUC 分别为 0.73、0.76、0.74 和 0.78，表明这些预测因素的预测能力没有显著差异。总之，本研究表明，BMI、FPG、sCPR 和 uCPR 是 2 型糖尿病患者未来胰岛素使用的强有力预测因素。
