Endocrine Abstracts

Introduction: Secondary failure (SF) to treatment with oral therapy is defined as the absence of a favorable reaction to the oral therapy which was effective in the previous course of the treatment. The aim of the work was to investigate the acute effects of the short-term insulin therapy on the secretory ability of endocrine pancreatic beta cells and the insulin resistance. Materials and Methods: 98 patients with diabetes mellitus type 2 (DM T2) and confirmed the SF to the oral therapy were selected for the study. These patients were divided into two different groups based on their body weight, and each group received a different insulin treatment regimens. The patients with a normal body mass (group A) were treated with a mono-insulin intensive conventional therapy (so called Basal-bolus regimen), while the group B patients (the group with an increased body mass) were treated with a combined insulin therapy (basal insulin plus metformin) in the duration of three months. All involved patients were tested prior to the insulin therapy and then three months after its startfor the factors of glycoregulation (glycated hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), 2h postprandial glucose (2h-PPG) and selfmonitoring of blood glucose (SMBG), and the homeostatic models for the estimation of values forthe insulin secretion and resistance (HOMA-β% and HOMA-IR) were calculated from the pairs of fasting glycemia and insulinemia. Main results: Results of the study show the improvement in glycoregulation, a decrease in insulin resistance (IR) and improvement in the endogenous pancreatic capacity for the both tested groups, when compared to the period prior to the insulin therapy started. Group A: FPG (9.5 vs 6.1, P < 0.001), 2h-PPG (11.6 vs 6.9, P < 0.001), HbA1c (9.0 vs 6.7, P < 0.001), HOMA-β% (39.03 vs 83.42, P < 0.001), HOMA-IR (4.87 vs 2.45, P < 0.001). Group B: FPG (9.4 vs 6.3, P < 0.001), 2h-PPG (11.6 vs 6.9, P < 0.001), HbA1c (9.0 vs 6.7, P < 0.001), HOMA-β% (54.8 vs 96.92, P < 0.001), HOMA-IR (7.27 vs 3.38, P < 0.001). Conclusion: The short-term insulin therapy, including normal-weight and overweight patients with DM T2 results in an improvement of glycoregulation, decrease in insulin resistance and recovery of secretory ability of beta cells of endocrine pancreas. Key words: secondary failure, diabetes mellitus type 2, HOMA-β%, HOMA-IR.