Background: Short-term intensive insulin therapy (SIIT) can reverse β cell dysfunction and induce glycemic remission in patients with newly diagnosed type 2 diabetes. Elimination of glucotoxicity to the maximum extent was considered the major mechanism. This study aimed to investigate the association of time in range (TIR) of predefined glycemic targets during SIIT with clinical outcomes after the therapy.
Methods: SIIT was given to 95 patients with newly diagnosed T2DM using insulin pump. Strict glycemic control (premeal, bedtime or 3am BG 3.9-6.0 mmol/L, 2hBG 3.9- 8.0 mmol/L) was achieved and maintained for 2 weeks. TIR was defined by calculating the percentage of daily eight-point blood glucose values (before and 2 hours after each meal, at bedtime and 3am) within the above-mentioned near-normoglycemic targets. Intravenous glucose tolerance tests were performed before and after SIIT with acute insulin response (AIR), HOMA IR and HOMA B calculated. Patients were followed for 1 year after withdrawal of insulin.
Results: Overall mean TIR was 68±11% during SIIT. After SIIT, both AIR and HOMA B increased while HOMA IR decreased. TIR during SIIT was significantly associated with improvement of AIR (r=0.36, P<0.001) but not with change of HOMA B (r=0.11, P=0.29) or HOMA IR (r=-0.17, P=0.11). One-year remission was observed in 59% (56/95) patients. Higher proportion of patients with TIR≥70% obtained glycemic remission for over 1 year compared with those with TIR<70% (71.4% vs. 49.1%, P=0.036) . In a logistic regression model, TIR≥70% was associated with higher 1- year glycemic remission after adjusting for Age, BMI and baseline A1c (OR 2.60, 95% CI 1.10-6. 13, P=0.03).
Conclusion: Higher TIR during SIIT indicates better recovery of βcell function and long-term glycemic outcomes.
L. Liu: None. L. Xu: None. W. Ke: None. P. Zhang: None. C. Xu: None. D. Zang: None. Y. Li: None.
National Key Research and Development Program of China (2018YFC1314100); Key Research and Development Program of Guangdong Province (2019B020230001); National Natural Science Foundation of China (81800716)