Intensive insulin lowers glycemic variability in early diabetes

HealthDay News — Short-term intensive insulin therapy (IIT) can improve β-cell function in type 2 diabetes and is associated with decreased glycemic variability, according to a study published in Diabetes Care.

High glycemic variability has been associated with hypoglycemia and diabetes complications, and β-cell dysfuction is thought to play a role, but little is known about whether improved β-cell function can improve patient outcomes.

So Caroline K. Kramer, MD, PhD, from Mount Sinai Hospital in Toronto, and colleagues examined whether β-cell functional recovery induced by short-term IIT correlated with improved glycemic variability. Sixty-one patients with type 2 diabetes (mean duration, three years) underwent four weeks of IIT.

β-cell function was assessed with the Insulin Secretion-Sensitivity Index-2 (ISSI-2) before and after IIT. Glucose variability was measured in the first and last week by the coefficient of variation of capillary glucose.

Overall, 55.7% of patients had a reduction in their glucose variability between the first and last week on IIT, the researchers found. There was a negative correlation between change in glucose variability and the change in β-cell function (P=0.008).

The only factor independently associated with the change in glucose variability was percentage change in ISSI-2 (P =0.03). Patients with a 25% or higher increase in ISSI-2 had a reduction in glucose variability, compared with their peers who had virtually no change (−0.041 versus −0.0002; P=0.006).

“It thus emerges that early in the course of [type 2 diabetes] glucose variability is a modifiable parameter for which intervention may mitigate future risk of adverse outcomes,” the researchers wrote.