Seghieri Marta, Rebelos Eleni, Mari Andrea, Sciangula Luigi, Giorda Carlo, Ferrannini Ele
Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy.
CNR Institute of Neuroscience, 35127 Padua, Italy.
J Clin Med. 2018 Aug 23;7(9):235. doi: 10.3390/jcm7090235.
The ß-cell dysfunction of type 2 diabetes is partly reversible. The optimal time window to induce glycemic remission is uncertain; short courses of insulin treatment have been tested as a strategy to induce remission. In a pilot study in 38 newly-diagnosed patients, we assessed the time-course of insulin sensitivity and ß-cell function (by repeat oral glucose tolerance tests) following a 6-week basal insulin treatment compared to metformin monotherapy in equipoised glycemic control. At 6 weeks, insulin secretion and sensitivity were increased in both groups whilst ß-cell glucose sensitivity was unchanged. From this time onwards, in the insulin group glycemia started to rise at 3 months, and was no longer different from baseline at 1 year. The initial improvement in insulin secretion and sensitivity dissipated. In the metformin group, fasting plasma glucose and HbA levels reached a nadir at 8 months, at which time insulin secretion, glucose and insulin sensitivity were significantly better than at baseline and higher than in the insulin group. A short course of basal insulin in newly-diagnosed patients does not appear to offer clinical advantage over recommended initiation with metformin.
2型糖尿病的β细胞功能障碍部分是可逆的。诱导血糖缓解的最佳时间窗尚不确定；短期胰岛素治疗已作为诱导缓解的一种策略进行了测试。在一项针对38例新诊断患者的试点研究中，我们评估了在血糖控制相当的情况下，与二甲双胍单药治疗相比，进行为期6周的基础胰岛素治疗后胰岛素敏感性和β细胞功能的时间进程（通过重复口服葡萄糖耐量试验）。6周时，两组的胰岛素分泌和敏感性均增加，而β细胞葡萄糖敏感性未改变。从此时起，胰岛素组的血糖在3个月时开始升高，1年时与基线无差异。胰岛素分泌和敏感性的最初改善消失。在二甲双胍组中，空腹血糖和HbA水平在8个月时达到最低点，此时胰岛素分泌、葡萄糖和胰岛素敏感性显著优于基线水平且高于胰岛素组。新诊断患者短期使用基础胰岛素似乎并不比推荐起始使用二甲双胍具有临床优势。
