Insulin/weight ratio may serve as a predictor of success during insulin pump therapy in type 2 diabetes patients: a proof-of-concept study
Shmuel Levit,
Yury Ivanovich Filippov,
Ohad Cohen,
Maria Weichman,
Joseph Azuri,
Yossi Manisteski,
Vyacheslav Moiseevich Levit https://doi.org/10.14341/DM2015170-77
Abstract
Aims.
To evaluate long-term efficacy of CSII for treating type 2 diabetes patients. To make an attempt to predict which patient would be more likely to reduce HbA1c levels (success) on CSII.
Methods.
18 Type 2 diabetes patients who began insulin pump therapy in our institute were included. All patients were previously treated by insulin with a mean duration of 54.9?51.4 months.
Results.
Mean duration of follow-up with CSII was 42.2?27.0 months. No significant changes were seen in HbA1c in total cohort (p=0.064), but fasting plasma glucose was reduced from 10,5?2,9 to 7,6?1,9 mmol/l, p=0.007. No weight gain and no severe hypoglycemia were noted. All patients were divided to three groups according to their HbA1c levels: those whose treatment was successful (A), failed (B) or neutral (C), (5, 8, 5 patients respectively). A difference was found in insulin/weight (IWR) ratio within the group A: 0.81?0.29 U/kg before vs. 0.41 ?0.12 U/kg on CSII, p=0.043. There was a difference in IWR on CSII in group A compared to group B (0.41 ?0.12 U/kg vs. 0.93?0.6 U/kg respectively, p=0.011). We also noted a trend of weight reduction in the group A vs. weight gain in the group B.
Conclusions.
CSII is a viable tool in insulin ? requiring type 2 diabetes persons, since the insulin dosing and release it provides are much more physiological. CSII is safe and effective for improving glycemic control, but not in all diabetes patients. We suggest IWR reduction may serve as an early predictor of success on CSII. This work may serve as a "proof-of-concept" study, demonstrating once again the fundamental role of strict weight control in type 2 diabetes. More studies are needed to explore and confirm our experience.
To evaluate long-term efficacy of CSII for treating type 2 diabetes patients. To make an attempt to predict which patient would be more likely to reduce HbA1c levels (success) on CSII.
Methods.
18 Type 2 diabetes patients who began insulin pump therapy in our institute were included. All patients were previously treated by insulin with a mean duration of 54.9?51.4 months.
Results.
Mean duration of follow-up with CSII was 42.2?27.0 months. No significant changes were seen in HbA1c in total cohort (p=0.064), but fasting plasma glucose was reduced from 10,5?2,9 to 7,6?1,9 mmol/l, p=0.007. No weight gain and no severe hypoglycemia were noted. All patients were divided to three groups according to their HbA1c levels: those whose treatment was successful (A), failed (B) or neutral (C), (5, 8, 5 patients respectively). A difference was found in insulin/weight (IWR) ratio within the group A: 0.81?0.29 U/kg before vs. 0.41 ?0.12 U/kg on CSII, p=0.043. There was a difference in IWR on CSII in group A compared to group B (0.41 ?0.12 U/kg vs. 0.93?0.6 U/kg respectively, p=0.011). We also noted a trend of weight reduction in the group A vs. weight gain in the group B.
Conclusions.
CSII is a viable tool in insulin ? requiring type 2 diabetes persons, since the insulin dosing and release it provides are much more physiological. CSII is safe and effective for improving glycemic control, but not in all diabetes patients. We suggest IWR reduction may serve as an early predictor of success on CSII. This work may serve as a "proof-of-concept" study, demonstrating once again the fundamental role of strict weight control in type 2 diabetes. More studies are needed to explore and confirm our experience.
About the Authors
Shmuel Levit
Institute of Endocrinology and Metabolism, Sheba medical center, Tel-Aviv
Israel
MD, PhD
Israel
MD, PhD
Yury Ivanovich Filippov
https://www.researchgate.net/profile/Yury_Philippov3
Endocrinology Research Centre, Moscow
Russian Federation
MD, Assistance Researcher in Program Education and Therapy Department of the Diabetes Institute
Endocrinology Research Centre, Moscow
Russian Federation
MD, Assistance Researcher in Program Education and Therapy Department of the Diabetes Institute
Ohad Cohen
Institute of Endocrinology, Diabetes & Metabolism, Chaim Sheba Medical Center, Tel Hashomer
Israel
Professor of Endocrinology
Israel
Professor of Endocrinology
Maria Weichman
Institute of Diabetes, Maccabi health Fund, Petah Tiqwa
Israel
Israel
Joseph Azuri
Maccabi Health Fund, department of research, Tel Aviv
Israel
MD
Israel
MD
Yossi Manisteski
Institute of Diabetes, Maccabi health Fund, Petah Tiqwa
Israel
MD
Israel
MD
Vyacheslav Moiseevich Levit
City Clinical Hospital №8, Chelyabinsk
Russian Federation
Head of the Disease prophylaxis department
Russian Federation
Head of the Disease prophylaxis department
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Review
For citations:
Levit Sh., Filippov Yu.I., Cohen O., Weichman M., Azuri J., Manisteski Y., Levit V.M. Insulin/weight ratio may serve as a predictor of success during insulin pump therapy in type 2 diabetes patients: a proof-of-concept study. Diabetes mellitus. 2015;18(1):70-77. https://doi.org/10.14341/DM2015170-77
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