Endocrine Abstracts

Introduction: Secondary failure (SF) of oral therapy in patients with type 2 diabetes is a common clinical phenomenon, which often puts the practitioner in a dilemma as to which therapeutic regimen to choose for continuing therapy. The dilemma primarily applies to patients in whom there is no clear clinical and biochemical evidence of significant insulin deficiency. This is precisely why there has been an increased interest in the use of short-term intermittent insulin therapy. The aim of the study was to examine the acute and residual effects of short-term mono insulin therapy on glycoregulation and insulin secretory function.

Methods: The prospective study took place in two phases and included 69 patients with type 2 DM and SF oral therapy. The first phase represents the introduction of insulin therapy (monoinsulin or combined) for three months, and the second phase represents the assessment of the residual effects of insulin therapy on glycoregulation and insulin secretory function (postinsulin period). During the second phase of the study, which lasted for 3 months, the patients again used the oral therapy they used until the diagnosis of SF. Glycoregulation and insulin secretory function were evaluated at the beginning and at the end of both phases.

Results: After three months of insulin therapy, there was a significant improvement in all observed parameters: morning glycemia (6.1 vs 9.5; P<0.001), postprandial glycemia (6.9 vs 11.6; P<0.001), glycemia from all-day profile (7.3 vs 10.3; P<0.001), while in the post-insulin period there was a certain deterioration of these parameters. Also, after three months of insulin therapy, the values of basal C-peptide increased (1.23 vs 1.67; P<0.001), while the level of basal insulinemia was reduced (9.17 vs 11.46; P<0.001). In the post-insulin period, there were no significant changes in C-peptide and insulin values compared to the period immediately after insulin therapy.

Conclusion: Short-term monoinsulin therapy represents a rational alternative to permanent insulin therapy in properly selected patients who do not have clear clinical and biochemical parameters of significant insulin deficiency. It can cause a state of re-sensitivity to oral therapy and delay permanent insulin treatment.