Oota Internal Medicine and Dental Clinic, 13-3, Hassamu, Nishi Ku, Sapporo, 063-0833, Japan.
J Med Case Rep. 2024 Sep 7;18(1):416. doi: 10.1186/s13256-024-04714-w.
This case report explores the long-term dynamics of insulin secretion and glycemic control in two patients with diabetes mellitus type 2 over 20 years. The observations underscore the impact of lifestyle interventions, including weight loss and calorie restriction, on insulin secretion patterns and glucose levels during 75 g oral glucose tolerance tests. Additionally, the role of hemoglobin A1c fluctuations, influenced by various factors such as body weight, exercise, and pharmacological interventions, is investigated.
Case 1 involves a Japanese woman now in her late 70s who successfully maintained her hemoglobin A1c below 7% for over two decades through sustained weight loss and lifestyle changes. Despite a gradual decline in the homeostasis model assessment of β cell function, the patient exhibited remarkable preservation of insulin secretion patterns over the 20-year follow-up. In case 2, a Japanese woman, now in her early 70s, experienced an improvement in hemoglobin A1c to 6.3% after a period of calorie limitation due to a wrist fracture in 2018. This incident seemed to trigger a temporary rescue of pancreatic β cell function, emphasizing the dynamic nature of insulin secretion. Both cases highlight the potential for pancreatic β cell rescue and underscore the persistence of insulin secretion over the 20-year follow-up. Additionally, we have briefly discussed three additional cases with follow-ups ranging from 10 to 17 years, demonstrating similar trends in glucose and insulin ratios.
Long-term lifestyle interventions, such as weight loss and calorie restriction, can preserve pancreatic β cell function and maintain glycemic control in type 2 diabetes patients over 20 years. Two patients showed stable or improved insulin secretion and favorable hemoglobin A1c levels, challenging the traditional view of irreversible β cell decline. The findings highlight the importance of personalized, nonpharmacological approaches, suggesting that sustained lifestyle changes can significantly impact diabetes management and potentially rescue β cell function.
本病例报告探讨了两名 2 型糖尿病患者 20 多年来胰岛素分泌和血糖控制的长期动态变化。这些观察结果强调了生活方式干预的影响，包括体重减轻和热量限制，对 75g 口服葡萄糖耐量试验期间胰岛素分泌模式和血糖水平的影响。此外，还研究了血红蛋白 A1c 波动的作用，血红蛋白 A1c 波动受体重、运动和药物干预等多种因素的影响。
病例 1 涉及一名现已 70 多岁的日本女性，她通过持续的体重减轻和生活方式改变，成功地将血红蛋白 A1c 维持在 7%以下超过 20 年。尽管β细胞功能的稳态模型评估逐渐下降，但患者在 20 年的随访中表现出显著的胰岛素分泌模式保留。在病例 2 中，一名现已 70 岁出头的日本女性在 2018 年因手腕骨折限制热量摄入后，血红蛋白 A1c 改善至 6.3%。这一事件似乎触发了胰腺β细胞功能的暂时挽救，强调了胰岛素分泌的动态性质。这两个病例都突出了胰腺β细胞挽救的可能性，并强调了在 20 年的随访中胰岛素分泌的持久性。此外，我们还简要讨论了另外三个随访时间从 10 年到 17 年的病例，这些病例显示了类似的血糖和胰岛素比值趋势。
长期的生活方式干预，如体重减轻和热量限制，可以在 20 多年的时间里维持 2 型糖尿病患者的胰腺β细胞功能和血糖控制。两名患者显示出稳定或改善的胰岛素分泌和良好的血红蛋白 A1c 水平，挑战了β细胞衰退不可逆转的传统观点。这些发现强调了个性化、非药物治疗方法的重要性，表明持续的生活方式改变可以显著影响糖尿病管理并可能挽救β细胞功能。
