Long-term Efficacy of Unloading Therapy for β cells after Short-term Intensive Insulin Therapy in Poorly Controlled Type 2 Diabetes

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  • Iwaki Masateru
    Department of Internal Medicine, Tokushima Municipal Hospital
  • Ishimaru Katsuo
    Department of Internal Medicine, Tokushima Municipal Hospital
  • Nakaya Yutaka
    Department of Nutrition and Metabolism, Institute of Health Biosciences, the University of Tokushima

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  • 短期強化インスリン療法とβ細胞保護療法を併用した2型糖尿病治療の有用性
  • タンキ キョウカ インスリン リョウホウ ト ベータ サイボウ ホゴ リョウホウ オ ヘイヨウシタ 2ガタ トウニョウビョウ チリョウ ノ ユウヨウセイ

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We tested the long-term effectiveness of combining short-term intensive insulin therapy (SIIT) and unloading therapy for βcells (UTB) in patients with poorly controlled (HbA1c≥8%) type 2 diabetes. After glucose toxicity was improved by SIIT, patients were treated using UTB, which included (1) combined α-glucosidase inhibitor and metformin, (2) a small dose of short-acting sulfonylurea, gliclazide, (3) control of hypertension and hyperlipidemia by angiotensin II receptor blockers and statins, and (4) lifestyle modification. Patients numbered 41 with diabetetes (60±13 years old) treated using UTB and followed up as outpatients. Only 4 had SIIT reinstituted due to poor control -3 who were severey obese (BMI≥34) and one using glibenclamide for 13 years. The remaining 37 maintained control fairly well (HbA1c<7.0%) with UTB over a mean follow-up of 35±22 months. Those who had no history of sulfonylurea use showed significantly higher success in discontinuing of gliclazide (83%) compared to those previously using sulfonylurea (37%). These results suggest that combining SIIT and UTB may improve glucose toxicity and overloading of β cells, e.g., postprandial hyperglycemia, insulin resistance, and oxidative stress and, in turn, preserve β cell function, suggesting the usefulness of this therapy in poorly controlled type 2 diabetes.

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