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Stojanovic J, Andjelic-Jelic M, Vuksanovic M, Marjanovic-Petkovic M, Jojic B, Stojanovic M, Beljic-Zivkovic T. The effects of early short-term insulin treatment vs. glimepiride on beta cell function in newly diagnosed type 2 diabetes with HbA1c above 9. Turk J Med Sci 2023; 53:552-562. [PMID: 37476884 PMCID: PMC10387975 DOI: 10.55730/1300-0144.5616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 01/20/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2D) is a complex metabolic impairment. Beta cell (BC) failure is the most challenging among its pathogenetic mechanisms. Recognizing reversible contributors to BC failure could guide individualized approach to early T2D treatment. The aim of this study was to compare early short-term insulin treatment vs. glimepiride, both added to metformin, on BC function, glycemic and lipid control, during 12-month follow-up. METHODS Eighty newly diagnosed T2D patients, 30-65 years of age, presenting with HbA1c ≥ 9% were enrolled in the study. They were randomly assigned to single-month initial insulin therapy (INS) added to metformin, or to glimepiride and metformin (OAD) as only treatment. Subjects assigned to initial insulin intervention were thereafter switched to OAD. C-peptide (C-Pep) was analyzed at baseline and 2 hours after standardized test meal (STM). All subjects were STM-retested after 3 and 12 months. HbA1c, serum lipids, BMI, HOMA IR, and HOMA B were assessed over follow-up. RESULTS HbA1c was lower in INS vs OAD at 3-months: 6.26 ± 0.18% vs 6.78 ± 0.10% (p = 0.016), remaining so by 12 months (p =0.056). BMI-adjusted ΔC-Pep was greater in INS vs. OAD at 3 months (4.60 ± 0.59 vs. 3.21 ± 0.34 m2 /kg; p = 0.044), persisting by 12months (4.57 ± 0.56 vs. 3.04 ± 0.34 m2/kg; p = 0.023). Average ΔC-Pep improvement from recruitment to 3 months was 100.8% in INS,vs. 51.3% in OAD. Prevalence of STM-ΔC-Pep response greater than 2.4 ng/mL had risen 3.2-fold by 12 months in the INS, vs. 2.4-fold only in the OAD group (p = 0.018). DISCUSSION Early short-term insulin intervention in newly diagnosed T2D improves beta cell function more than glimepiride, both added to metformin, resulting in a superior and longer lasting glycemic and lipid control.
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Affiliation(s)
- Jelena Stojanovic
- Division of Endocrinology, Diabetes and Metabolic Disorders, Department of Internal Medicine, Zvezdara University Medical Center, Belgrade, Serbia
| | - Marina Andjelic-Jelic
- Department of Internal Medicine, Faculty of Dental Medicine, University of Belgrade, Belgrade, Serbia ; Division of Endocrinology, Diabetes and Metabolic Disorders, Department of Internal Medicine,Zvezdara University Medical Center, Belgrade, Serbia
| | - Miljanka Vuksanovic
- Department of Internal Medicine, Medical Faculty,University of Belgrade, Belgrade, Serbia ; Division of Endocrinology, Diabetes and Metabolic Disorders, Department of Internal Medicine,Zvezdara University Medical Center, Belgrade, Serbia
| | - Milica Marjanovic-Petkovic
- Department of Internal Medicine, Medical Faculty,University of Belgrade, Belgrade, Serbia; Division of Endocrinology, Diabetes and Metabolic Disorders, Department of Internal Medicine,Zvezdara University Medical Center, Belgrade, Serbia
| | - Biljana Jojic
- Division of Endocrinology, Diabetes and Metabolic Disorders, Department of Internal Medicine,Zvezdara University Medical Center, Belgrade, Serbia
| | - Marko Stojanovic
- Department of Internal Medicine, Medical Faculty,University of Belgrade, Belgrade, Serbia ; Department of Neuroendocrinology, Clinic for Endocrinology, Diabetes and Metabolic Diseases,University Clinical Center of Serbia, Belgrade, Serbia
| | - Teodora Beljic-Zivkovic
- Department of Internal Medicine, Medical Faculty,University of Belgrade, Belgrade, Serbia;Division of Endocrinology, Diabetes and Metabolic Disorders, Department of Internal Medicine,Zvezdara University Medical Center, Belgrade, Serbia
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