Effects of Insulin Therapy and Oral Hypoglycemic Agents on Glycemic Control for Type 2 Diabetes Mellitus Patients in China–A Case Control Study

Abstract

Objective The purpose of the study was to compare glycemic control in patients with type 2 diabetes (T2DM) receiving insulin therapy (IT) or oral hypoglycemic agents (OHA), and explore associations between treatment modality and pancreatic beta-cell function.

Methods A matched, case-control study was conducted from April, 2016 to November, 2016. 2 272 patients with T2DM were identified from electronic medical records at four academic hospitals in China. Based on 1 136 eligible patients using IT, eligible 1 136 OHA patients were matched by age and duration at a ratio of 1:1. Logistic regression was used to examine the relationship between IT and glycemic control. Multiple linear regression addressed impact factors of HOMA-β.

Results There was no significant difference between IT and OHA groups in gender, age, diabetes duration, body mass index (BMI), fasting plasma glucose (FPG), systolic blood pressure (SBP), serum lipids and smoking history (p>0.05). We stratified subjects by diabetes duration, only when the duration was less than 5 years, HbA1c in OHA group was superior to IT (P=0.017). There were no significant differences between groups in HbA1c when disease duration was≥5 years. Even in subjects with short diabetes duration (<5 years), IT did not significantly impact glycemic control (p=0.071, OR=0.577). Multiple linear regression analysis showed that IT (p=0.001), diabetes duration (p=0.038), BMI (P<0.001), sulfonylurea use (P=0.001) were significant and independent predictors of HOMA-β.

Conclusions In patients with short diabetes duration (<5 years), oral hypoglycemic therapy achieved better glycemic control than insulin therapy. Moreover, insulin use was not an impact factor of poor glycemic control. In addition, using insulin can protect beta-cell function.

Key words

beta-cell function - glycemic control - insulin therapy - oral hypoglycemic agents - type 2 diabetes mellitus

Publikationsverlauf

Eingereicht: 19. November 2018
Eingereicht: 25. Februar 2019

Angenommen: 21. März 2019

Artikel online veröffentlicht:
08. April 2019

• References

• 1 Gu D, Reynolds K, Duan X. et al. Prevalence of diabetes and impaired fasting glucose in the Chinese adult population: International Collaborative Study of Cardiovascular Disease in Asia (InterASIA). Diabetologia 2003; 46: 1190-1198
• 2 King H, Aubert RE, Herman WH. Global burden of diabetes, 1995–2025: Prevalence, numerical estimates, and projections. Diabetes Care 1998; 21: 1414-1431
• 3 International Diabetes Federation. IDF Diabetes Atlas. 7th Edition 2015
• 4 Ishiguro Hajime, Kodama Satoru, Horikawa Chika. et al. In search of the ideal resistance training program to improve glycemic control and its indication for patients with type 2 diabetes mellitus: A systematic review and meta-analysis. Sports Medicine 2016; 46: 67-77
• 5 Xiao-hui Guo, Yuan Li, Qing-qing Lou. et al. A nationwide survey of diabetes education, self-management and glycemic control in patients with type 2 diabetes in China. Chinese Medical Journal 2012; 125: 4175-4180
• 6 Suh DC, Choi IS, Plauschinat C. et al. Impact of comorbid conditions and race/ethnicity on glycemic control among the US population with type 2 diabetes, 1988-1994 to 1999-2004. Diabetes Complications 2010; 24: 382-391
• 7 Yu Xu, Limin Wang, Jiang He. et al. Prevalence and Control of Diabetes in Chinese Adults. JAMA 2013; 310: 948-958
• 8 Pan C, Yang W, Jia W. et al. Management of Chinese patients with type 2 diabetes, 1998–2006: The Diabcare-China surveys. Current Medical Research and Opinion 2009; 25: 39-45
• 9 Lin Liu, Qingqing Lou, Xiaohui Guo. et al. Management status and its predictive factors in patients with type 2 diabetes in China: A Nationwide Multicenter Study. Diabetes Metab Res Rev 2015; 31: 811-816
• 10 Joya-Galeana J, Fernandez M, Cervera A. et al. Effects of insulin and oral antidiabetic agents on glucose metabolism, vascular dysfunction and skeletal muscle inflammation in type 2 diabetic subjects. Diabetes Metab Res Rev 2011; 27: 373-382
• 11 Prospective Diabetes Study Group . U.K. prospective diabetes study 16: Overview of 6 years’ therapy of type 2 diabetes: a progressive disease. Diabetes 1995; 44: 1249-1258
• 12 Saisho Y. β-cell dysfunction: Its critical role in prevention and management of type 2 diabetes. World Journal of Diabetes 2015; 6: 109-124
• 13 Kahn SE, Lachin JM, Zinman B. et al. Effects of rosiglitazone, glyburide and metformin on β-cell function and insulin sensitivity in ADOPT. Diabetes 2011; 60: 1552-1560
• 14 Scheen AJ. Antidiabetic agents in subjects with mild dysglycaemia: Prevention or early treatment of type 2 diabetes?. Diabetes & Metabolism 2007; 33: 3-12
• 15 Kuzuya Takeshi, Nakagawa Shoichi, Satoh Jo. et al. Report of the Committee on the classification and diagnostic criteria of diabetes mellitus. Diabetes Research and Clinical Practice 2002; 55: 65-85
• 16 Matthews DR, Hosker JP, Rudenski AS. et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412-419
• 17 Chinese Diabetes Society.. China Guideline for Type 2 Diabetes (2017). Chin J Diabetes Mellitus 2018; 10: 12
• 18 Umpierrez GE, Cardona S, Chachkhiani D. et al. A randomized controlled study comparing a DPP4 Inhibitor (Linagliptin) and Basal Insulin (Glargine) in patients with type 2 diabetes in long-term care and skilled nursing facilities: Linagliptin-LTC Trial. AMDA-The Society for Post-Acute and Long-Term Care Medicine 2017; 19: 399-404
• 19 Sapkota RajuP, Upadhyaya Tirthalal, Gurung Govind. et al. Need to improve awareness and treatment compliance in high-risk patients for diabetic complications in Nepal. BMJ Open Diabetes Research & Care 2018; 6: e000525
• 20 Rockville Sharon L. Edelstein et al. Impact of insulin and metformin versus metformin alone on β-Cell function in youth with impaired glucose tolerance or recently diagnosed type 2 diabetes. Diabetes Care 2018; 41: 1717-1725
• 21 Kramer CK, Zinman B, Retnakaran R. Short-term intensive insulin therapy in type 2 diabetes: A systematic review and meta-analysis. The Lancet Diabetes & Endocrinology 2013; 1: 28-34
• 22 Hu Y, Li L, Xu Y. et al. Short-term intensive therapy in newly diagnosed type 2 diabetes partially restores both insulin sensitivity and beta-cell function in subjects with long-term remission. Diabetes Care 2011; 34: 1848-1853
• 23 Kramer CK, Choi H, Zinman B. et al. Determinants of reversibility of beta-cell dysfunction in response to short-term intensive insulin therapy in early type 2 diabetes. Am J Physiol Endocrinol Metab 2013; 305: E1398-E1407
• 24 Weng J, Li Y, Xu W. et al. Effect of intensive insulin therapy on β-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: A multicentre randomised parallel-group trial. Lancet 2008; 371: 1753-1760
• 25 Kramer CK, Zinman B, Choi H. et al. Predictors of sustained drug-free diabetes remission over 48 weeks following short-term intensive insulin therapy in early type 2 diabetes. BMJ Open Diabetes Research & Care 2016; 4: e000270
• 26 Kahn SE, Haffner SM, Heise MA. et al. Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy. The New England Journal of Medicine 2006; 355: 2427-2443
• 27 Shin MS, Yu JH, Jung CH. et al. The duration of sulfonylurea treatment is associated with beta-cell dysfunction in patients with type 2 diabetes mellitusJ. Diabetes Technology & Therapeutics 2012; 14: 1033-1042