Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2010) 24 OP1.3

BSPED2010 Oral Presentations (RCN CYP diabetes session) (1) (5 abstracts)

Intensive insulin therapy in adolescent type 2 diabetes

B White , P C Hindmarsh & R M Viner


UCL Institute of Child Health, London, UK.


Background: Glucolipotoxicity contributes to declining B-cell function and acceleration of type 2 diabetes (T2DM). Intensive insulin therapy has been shown to rapidly reverse glucolipotoxicity and improve B-cell function, particularly if given soon after diagnosis. Recent trials in adults have shown promise, with 50% in remission at 1 year after intensive insulin therapy.

Methods: We report 4 cases of young people with T2DM treated with intravenous insulin for 2 weeks (blood glucose clamped between 4–7 mmol/L using insulin sliding scale). Three were recently diagnosed (<6 months) and were insulin and metformin-naïve. One recently diagnosed adolescent was lean (BMI 17.3 kg/m2), the remainder were obese (BMI 35.2–44.6 kg/m2).

Results: Remission (defined as normoglycaemia without insulin or metformin treatment) was achieved in all 3 patients with recent onset T2DM. Of these, one obese subject continues to have good diabetes control (A1c 6.5%) without treatment after 9 months follow-up, while a second obese subject required metformin 6 months after treatment (current A1c 6.4% on metformin 1 g/day, 27 months after treatment). The lean subject required metformin within 6 weeks of treatment (current A1c 7.9%, on metformin 1 g and rosiglitazone 4 mg/day). The patient with pre-existing T2DM on insulin achieved remission 2 weeks after treatment and developed difficult to control hypoglycaemic episodes reflective of B-cell dysregulation (3 months off treatment, now on insulin pump, A1c 11.1%).

Conclusions: We report a disappointing experience with intensive insulin therapy in young people with type 2 diabetes. However, prolonged remission and good glycaemic control was achieved in the both obese subjects with recent onset diabetes, suggesting further work is required to identify whether intensive insulin therapy at diagnosis may benefit selected patients.

Volume 24

38th Meeting of the British Society for Paediatric Endocrinology and Diabetes

British Society for Paediatric Endocrinology and Diabetes 

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