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P-35 Study of metabolic control, body weight, body mass index and blood pressure in patients with Type 2 diabetes with insulin resistance with intensified insulin therapy
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DIABETES RESEARCH A N D CLINICAL PRACTICE
overall incidence of Treatment-Emergent Adverse Events and hypoglycemia rate per 30 days were similar between groups. Conclusions: Treatment with lispro mix 50 significantly improved 2-h PPBG excursion following a standard test meal without an increase in hypoglycemia compared to human insulin mix 50 in insulin-treated diabetes patients. Lispro mix 50 provided similar HbA1c control compared to human insulin mix 50. Mean FBG was higher with lispro mix 50 than with human insulin mix 50. Lispro mix 50 was generally well tolerated by patients treated for 3 months. This study was sponsored by Eli Lilly & Company.
P-35 Study of metabolic control, body weight, body mass index and blood pressure in patients with Type 2 diabetes with insulin resistance with intensified insulin therapy Anil Kumar, Reddy Iska Diabetes Center, Pogathota, Nellore, AP, India Background and aims: Type 2 diabetes is a heterogeneous group of diseases with variable degree of insulin resistance and insulin deficiency. Intensified insulin therapy (IIT) with pre-prandial regular insulin and long acting insulin overnight is superior for glycaemic control than conventional insulin therapy (CIT) with pre-mixed regular and long acting insulin twice a day. Materials and methods: A total of 606 Type 2 diabetes patients with insulin resistance, aged 40-50 years, duration of diabetes 5-6 years, and taking insulin were enrolled in the study carried out at the daily out-patient clinic of the Diabetes Research Center, Pogathota, Nellore, A.P. India, from April 2006 to July 2007. Patients with two or less injections per day were regarded as CIT and more than 2 insulin injections per day as IIT. Blood pressure (BP), body weight, BMI, and HbA1c levels are measured at the beginning of the study and 6 months later. Results: CIT patients (n =167) and IIT (n = 439). Patients receiving CIT at baseline had lower weight (p<0.05), BMI (p<0.05) and BP (p<0.05). At re-examination after 6 months both groups had significantly lower HbA1c (p<0.001) body weight (p<0.001) and BMI (p<0.001). BP control was significant improved in patients with IIT (p<0.001). Conclusion: Metabolic control in terms of HbA1c does not differ between IIT and CIT, but BP control and quality of life was significantly better in patients receiving IIT.
P-36 The effect of morning intermediate insulin and night-time long acting insulin therapy in patients with Type 2 diabetes Yonghyun Kim, Donghyun Shin Bungdang Jesaeng Hospital, South Korea Background: The most commonly used type of insulin therapy in patients with Type 2 diabetes who failed with oral antidiabetic therapy is intermediate acting insulin once a day or premixed insulin twice a day. But adequate control of blood glucose is more difficult in patients treated with insulin than patients on oral antidiabetic treatment. The main reason is more frequent hypoglycemic events in patients with insulin treatment. This leads to adequate titration of insulin injection dose not being conducted properly. Night-time hypoglycemia is a more troublesome discomfort, so many patients treated with twice a day insulin injections often skip pre-supper insulin by themselves. Also, in cases of once a day morning injection, many patients refuse to add pre-supper insulin injection because they often eat supper out due to their working environment. Recently long acting insulin, insulin glargine, has become available. The major ad-
79 (2008) S1 – S127
vantage of this insulin is less hypoglycemic events when fasting glucose level is controlled adequately and night-time injection is possible to control fasting glucose level. But postprandial glucose is not controlled well with long acting insulin alone, so other methods of decreasing postprandial glucose are needed. Methods: We recruited 25 patients with Type 2 diabetes treated with insulin once or twice a day, with inadequate glucose control, (>9.0% HgA1c level). Insulin treatment was changed to morning intermediate insulin and night-time insulin glargine injection in all patients. The starting dose was determined by the sum of previous insulin dose and degree of fasting hyperglycemia. Morning insulin dose was modified by postprandial glucose level of lunch and supper, aimed at 200mg/dL. Nighttime insulin dose was altered by fasting glucose level aimed at 80-120mg/dL. The degree of glucose control was compared by HbA1c levels before and after 3 months of treatment. The frequency of hypoglycemic events was also compared. Result: Thirteen of the 25 patients had an improvement in their glycemic control in terms of HbA1c level. The total insulin dose needed for adequate glycemic control was increased, but the frequency of hypoglycemic events was not increased when fasting glucose was well controlled with insulin glargine. Conclusion: In some insulin treated patients with Type 2 diabetes who cannot increase their insulin dose because of fear of hypoglycemia or refuse to pre-supper insulin injection because of their working environment, in spite of poor glycemic control, morning intermediate insulin injection and night-time long acting insulin injection therapy can be alternative insulin treatments. This treatment regime has fewer hypoglycemia events without disturbing the patient’s usual style of social life.
P-37 Usefulness of C-peptide value for estimating pancreatic β-cell function: Application to the assessment of insulin therapy for Type 2 diabetes Akihiro Hamasaki 1 , Takao Taniguchi 2 , Yo Aramaki 2 , Motozumi Okamoto 1,2 , Shunsuke Yamane 1 , Shimpei Fujimoto 1 , Masaya Hosokawa 1 , Yutaka Seino 1,3 , Nobuya Inagaki 1 1 Department of Diabetes and Clinical Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan, 2 Department of Internal Medicine, Otsu Red Cross Hospital, Otsu, Shiga, Japan, 3 Kansai Electric Power Hospital, Osaka, Japan Evaluation of endogenous insulin secretion is an important factor in the selection of the medical treatment for Type 2 diabetes. Values of C-peptide (CPR) and several indices based on the CPR value are used clinically for estimating pancreatic βcell function. The standard clinical application of those indices, however, is not well established. To clarify the appropriate index values for assessing medical treatment and to examine the usefulness of these values, we investigated the relationship between the index values and the therapeutic requirement for medication. Fasting and postprandial (2 h) serum samples were collected from patients with Type 2 diabetes (n=220) hospitalized to achieve glycemic control. Fasting CPR (fCPR), postprandial CPR (2hCPR), fCPR-index [fCPR/fasting blood glucose (fBG)], 2hCPRindex (2hCPR/postprandial BG), and SUIT (secretory units of islets in transplantation) index [250*fCPR (nM)/(fBG (mM) – 3.43)] (Yamada et al. Diabetes Res Clin Pract. 74, 2006) were correlated with the incremental CPR response (δCPR: 2hCPR - fCPR). Sixty-five cases for which serum samples were collected on both admission and discharge were divided into three groups depending on the insulin requirement at the time of discharge (H: >10 U/day, L: 1-10 U/day, W: without). The index values were significantly lower in the H group on both admission and discharge. The index values improved during hospitalization, particularly in the W group. Receiver operating characteristic (ROC) curve analyses indicated
DIABETES RESEARCH A N D CLINICAL PRACTICE
overall incidence of Treatment-Emergent Adverse Events and hypoglycemia rate per 30 days were similar between groups. Conclusions: Treatment with lispro mix 50 significantly improved 2-h PPBG excursion following a standard test meal without an increase in hypoglycemia compared to human insulin mix 50 in insulin-treated diabetes patients. Lispro mix 50 provided similar HbA1c control compared to human insulin mix 50. Mean FBG was higher with lispro mix 50 than with human insulin mix 50. Lispro mix 50 was generally well tolerated by patients treated for 3 months. This study was sponsored by Eli Lilly & Company.
P-35 Study of metabolic control, body weight, body mass index and blood pressure in patients with Type 2 diabetes with insulin resistance with intensified insulin therapy Anil Kumar, Reddy Iska Diabetes Center, Pogathota, Nellore, AP, India Background and aims: Type 2 diabetes is a heterogeneous group of diseases with variable degree of insulin resistance and insulin deficiency. Intensified insulin therapy (IIT) with pre-prandial regular insulin and long acting insulin overnight is superior for glycaemic control than conventional insulin therapy (CIT) with pre-mixed regular and long acting insulin twice a day. Materials and methods: A total of 606 Type 2 diabetes patients with insulin resistance, aged 40-50 years, duration of diabetes 5-6 years, and taking insulin were enrolled in the study carried out at the daily out-patient clinic of the Diabetes Research Center, Pogathota, Nellore, A.P. India, from April 2006 to July 2007. Patients with two or less injections per day were regarded as CIT and more than 2 insulin injections per day as IIT. Blood pressure (BP), body weight, BMI, and HbA1c levels are measured at the beginning of the study and 6 months later. Results: CIT patients (n =167) and IIT (n = 439). Patients receiving CIT at baseline had lower weight (p<0.05), BMI (p<0.05) and BP (p<0.05). At re-examination after 6 months both groups had significantly lower HbA1c (p<0.001) body weight (p<0.001) and BMI (p<0.001). BP control was significant improved in patients with IIT (p<0.001). Conclusion: Metabolic control in terms of HbA1c does not differ between IIT and CIT, but BP control and quality of life was significantly better in patients receiving IIT.
P-36 The effect of morning intermediate insulin and night-time long acting insulin therapy in patients with Type 2 diabetes Yonghyun Kim, Donghyun Shin Bungdang Jesaeng Hospital, South Korea Background: The most commonly used type of insulin therapy in patients with Type 2 diabetes who failed with oral antidiabetic therapy is intermediate acting insulin once a day or premixed insulin twice a day. But adequate control of blood glucose is more difficult in patients treated with insulin than patients on oral antidiabetic treatment. The main reason is more frequent hypoglycemic events in patients with insulin treatment. This leads to adequate titration of insulin injection dose not being conducted properly. Night-time hypoglycemia is a more troublesome discomfort, so many patients treated with twice a day insulin injections often skip pre-supper insulin by themselves. Also, in cases of once a day morning injection, many patients refuse to add pre-supper insulin injection because they often eat supper out due to their working environment. Recently long acting insulin, insulin glargine, has become available. The major ad-
79 (2008) S1 – S127
vantage of this insulin is less hypoglycemic events when fasting glucose level is controlled adequately and night-time injection is possible to control fasting glucose level. But postprandial glucose is not controlled well with long acting insulin alone, so other methods of decreasing postprandial glucose are needed. Methods: We recruited 25 patients with Type 2 diabetes treated with insulin once or twice a day, with inadequate glucose control, (>9.0% HgA1c level). Insulin treatment was changed to morning intermediate insulin and night-time insulin glargine injection in all patients. The starting dose was determined by the sum of previous insulin dose and degree of fasting hyperglycemia. Morning insulin dose was modified by postprandial glucose level of lunch and supper, aimed at 200mg/dL. Nighttime insulin dose was altered by fasting glucose level aimed at 80-120mg/dL. The degree of glucose control was compared by HbA1c levels before and after 3 months of treatment. The frequency of hypoglycemic events was also compared. Result: Thirteen of the 25 patients had an improvement in their glycemic control in terms of HbA1c level. The total insulin dose needed for adequate glycemic control was increased, but the frequency of hypoglycemic events was not increased when fasting glucose was well controlled with insulin glargine. Conclusion: In some insulin treated patients with Type 2 diabetes who cannot increase their insulin dose because of fear of hypoglycemia or refuse to pre-supper insulin injection because of their working environment, in spite of poor glycemic control, morning intermediate insulin injection and night-time long acting insulin injection therapy can be alternative insulin treatments. This treatment regime has fewer hypoglycemia events without disturbing the patient’s usual style of social life.
P-37 Usefulness of C-peptide value for estimating pancreatic β-cell function: Application to the assessment of insulin therapy for Type 2 diabetes Akihiro Hamasaki 1 , Takao Taniguchi 2 , Yo Aramaki 2 , Motozumi Okamoto 1,2 , Shunsuke Yamane 1 , Shimpei Fujimoto 1 , Masaya Hosokawa 1 , Yutaka Seino 1,3 , Nobuya Inagaki 1 1 Department of Diabetes and Clinical Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan, 2 Department of Internal Medicine, Otsu Red Cross Hospital, Otsu, Shiga, Japan, 3 Kansai Electric Power Hospital, Osaka, Japan Evaluation of endogenous insulin secretion is an important factor in the selection of the medical treatment for Type 2 diabetes. Values of C-peptide (CPR) and several indices based on the CPR value are used clinically for estimating pancreatic βcell function. The standard clinical application of those indices, however, is not well established. To clarify the appropriate index values for assessing medical treatment and to examine the usefulness of these values, we investigated the relationship between the index values and the therapeutic requirement for medication. Fasting and postprandial (2 h) serum samples were collected from patients with Type 2 diabetes (n=220) hospitalized to achieve glycemic control. Fasting CPR (fCPR), postprandial CPR (2hCPR), fCPR-index [fCPR/fasting blood glucose (fBG)], 2hCPRindex (2hCPR/postprandial BG), and SUIT (secretory units of islets in transplantation) index [250*fCPR (nM)/(fBG (mM) – 3.43)] (Yamada et al. Diabetes Res Clin Pract. 74, 2006) were correlated with the incremental CPR response (δCPR: 2hCPR - fCPR). Sixty-five cases for which serum samples were collected on both admission and discharge were divided into three groups depending on the insulin requirement at the time of discharge (H: >10 U/day, L: 1-10 U/day, W: without). The index values were significantly lower in the H group on both admission and discharge. The index values improved during hospitalization, particularly in the W group. Receiver operating characteristic (ROC) curve analyses indicated