TITLE

Effect of interactions between C peptide levels and insulin treatment on clinical outcomes among patients with type 2 diabetes mellitus

AUTHOR(S)
Ko, Gary T.C.; So, Wing-Yee; Tong, Peter C.; Chan, Wing-Bun; Xilin Yang; Ma, Ronald C.; Kong, Alice P.; Ozaki, Risa; Yeung, Chun-Yip; Chow, Chun-Chung; Chan, Juliana C.
PUB. DATE
April 2009
SOURCE
CMAJ: Canadian Medical Association Journal;4/28/2009, Vol. 180 Issue 9, p919
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: A recently halted clinical trial showed that intensive treatment of type 2 diabetes mellitus was associated with increased mortality. Given the phenotypic heterogeneity of diabetes, therapy targeted at insulin status may maximize benefits and minimize harm. Methods: In this longitudinal cohort study, we followed 503 patients with type 2 diabetes who were free of cardiovascular disease from 1996 until data on mortality and cardiovascular outcomes were censored in 2005. Phenotype-targeted therapy was defined as use of insulin therapy in patients with a fasting plasma C peptide level of 0.2 nmol/L or less and no insulin therapy in patients with higher C peptide levels. Results: The mean age of the cohort was 54.4 (standard deviation 13.1) years, and 56% were women. The mean duration of diabetes was 4.6 years (range 0-35.9 years). Of the 503 patients, 110 (21.9%) had a low C peptide level and 111 (22.1%) were given insulin. Based on their C peptide status, 338 patients (67.2%) received phenotype-targeted therapy (non-insulin-treated, high C peptide level [n = 310] or insulin-treated, low C peptide level [n = 28]), and 165 patients (32.8%) received non-phenotype-targeted therapy (non-insulin-treated, low C peptide level [n = 82] or insulintreated, high C peptide level [n = 83]). Compared with the insulin-treated, low-C-peptide referent group, the insulintreated, high-C-peptide group was at a significantly higher risk of cardiovascular events (hazard ratio [HR] 2.85, p = 0.049) and death (HR 3.43, p = 0.043); the risk was not significantly higher in the other 2 groups. These differences were no longer significant after adjusting for age, sex and diabetes duration. Interpretation: Patients with low C peptide levels who received insulin had the best clinical outcomes. Patients with normal to high C peptide levels who received insulin had the worst clinical outcomes. The results suggest that phenotype-targeted insulin therapy may be important in treating diabetes.
ACCESSION #
38217630

 

Related Articles

  • Markers for insulin dependent diabetes: towards early detection. Wilkin, Terence; Armitage, Mary // British Medical Journal (Clinical Research Edition);11/22/1986, Vol. 293 Issue 6558, p1323 

    Reports the use of markers in the early detection of insulin dependent diabetes. Destruction of the islet cell mass; Function of insulin antibodies; Description of activated lymphocytes.

  • Expression of Mesenchymal and α-Cell PhenotypicMarkers in Islet β-Cells in Recently Diagnosed Diabetes. WHITE, MICHAEL G.; MARSHALL, HELEN L.; RIGBY, REBECCA; GUO CAI HUANG; AMER, AIMEN; BOOTH, TREVOR; WHITE, STEVE; SHAW, JAMES A. M. // Diabetes Care;Nov2013, Vol. 36 Issue 11, p3818 

    OBJECTIVE-Relative contributions of reversible b-cell dysfunction and true decrease in b-cell mass in type 2 diabetes remain unclear. Definitive rodent lineage-tracing studies have identified b-cell dedifferentiation and subsequent reprogramming to a-cell fate as a novel mechanism underlying...

  • Immunomodulatory therapy to preserve pancreatic β-cell function in type 1 diabetes. Waldron-Lynch, Frank; Herold, Kevan C. // Nature Reviews Drug Discovery;Jun2011, Vol. 10 Issue 6, p439 

    Type 1 diabetes is a common, severe chronic autoimmune disease that is characterized by the progressive and insidious loss of self-tolerance to the insulin-producing pancreatic islet β-cells. This loss of self-tolerance leads to the destruction of β-cells and the development of overt...

  • The Metabolic Progression to Type 1 Diabetes as Indicated by Serial Oral Glucose Tolerance Testing in the Diabetes Prevention Trial--Type 1. Sosenko, Jay M.; Skyler, Jay S.; Herold, Kevan C.; Palmer, Jerry P. // Diabetes;Jun2012, Vol. 61 Issue 6, p1331 

    The article describes the development and progression of metabolic abnormalities in patients with type 1 diabetes (T1D) based in two studies of the Diabetes Prevention Trial-Type 1 (DPT-1). Participants in the studies were required to undergo islet cell autoantibody (ICA) positivity test,...

  • Islet Transplantation Is Associated With an Improvement of Cardiovascular Function in Type 1 Diabetic Kidney Transplant Patients. Fiorina, Paolo; Gremizzi, Chiara; Maffi, Paola; Caldara, Rossana; Tavano, Davide; Monti, Lucilla; Socci, Carlo; Folli, Franco; Fazio, Ferruccio; Astorri, Ettore; Del Maschio, Alessandro; Secchi, Antonio // Diabetes Care;Jun2005, Vol. 28 Issue 6, p1358 

    OBJECTIVE -- Cardiovascular mortality and morbidity are major problems in type 1 diabetic patients with end-stage renal disease (ESRD). The aim of this study was to determine whether islet transplantation can improve cardiovascular function in these patients. RESEARCH DESIGN AND METHODS -- We...

  • Minimal Functional β-CellMass in Intraportal Implants That Reduces Glycemic Variability in Type 1 Diabetic Recipients. GILLARD, PIETER; HILBRANDS, ROBERT; VAN DE VELDE, URSULE; ZHIDONG LING; DA HAE LEE; WEETS, ILSE; GORUS, FRANS; DE BLOCK, CHRISTOPHE; KAUFMAN, LEONARD; MATHIEU, CHANTAL; PIPELEERS, DANIEL; KEYMEULEN, BART // Diabetes Care;Nov2013, Vol. 36 Issue 11, p3483 

    OBJECTIVE-Previous work has shown a correlation between b-cell number in cultured islet cell grafts and their ability to induce C-peptide secretion after intraportal implantation in C-peptide-negative type1 diabetic patients. In this cross-sectional study, we examined the minimal functional...

  • B-Cells Promote Intra-Islet CD8+ Cytotoxic T-Cell Survival to Enhance Type 1 Diabetes. Brodie, Gillian M.; Wallberg, Maja; Santamaria, Pere; Wong, F. Susan; Green, E. Allison // Diabetes;Apr2008, Vol. 57 Issue 4, p909 

    OBJECTIVE--To determine the role of B-cells in promoting CD8[sup +] T-cell--mediated β cell destruction in chronically inflamed islets. RESEARCH DESIGN AND METHODS--RIP-TNFα-NOD mice were crossed to B-cell-deficient NOD mice, and diabetes development was monitored. We used in vitro...

  • CM Tools and Pearls: The Canadian Diabetes Association 2013 Clinical Practice Guidelines. Gilmour, Julie; Yu, Catherine // Canadian Journal of General Internal Medicine;2015, Vol. 10 Issue 3, p18 

    Diabetes is common in Canada, and over the last decade, the incidence of diabetes has grown rapidly. The Canadian Diabetes Association (CDA) released the 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada (CPGs) in April 2013. These internationally...

  • Translating "Nondiabetic" A1C Levels to Clinical Practice. Cefalu, William T. // Diabetes;Aug2010, Vol. 59 Issue 8, p1868 

    The author discusses the significance of the clinical translation of current A1C data in the nondiabetic range to clinical practice. He mentions key findings in A1C data including the importance of glycemia in contributing to cardiovascular disease (CVD) and the significance of higher A1C level...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics