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Lower Mean Blood Glucose during Short-term Intensive Insulin Therapy is Associated with Long-term Glycemic Remission in Patients with Newly Diagnosed Type 2 Diabetes: Evidence-based Recommendations for Standardization.

Lower Mean Blood Glucose during Short-term Intensive Insulin Therapy is Associated with Long-term Glycemic Remission in Patients with Newly Diagnosed Type 2 Diabetes: Evidence-based Recommendations for Standardization.
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Liu L, Liu J, Xu L, Ke W, Wan X, Li H, He X, Wang L, Cao X, Xiao H, Li Y,


Liu L, Liu J, Xu L, Ke W, Wan X, Li H, He X, Wang L, Cao X, Xiao H, Li Y, (click to view)

Liu L, Liu J, Xu L, Ke W, Wan X, Li H, He X, Wang L, Cao X, Xiao H, Li Y,

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Journal of diabetes investigation 2017 11 30() doi 10.1111/jdi.12782
Abstract
AIMS/INTRODUCTION
Optimal glycemic targets during short-term intensive insulin therapy in patients with newly diagnosed type 2 diabetes were not standardized. This study is performed to determine the optimal glycemic targets during the therapy by analyzing the impacts of glucose levels on therapeutic outcomes.

MATERIALS AND METHODS
Nighty-five subjects with newly diagnosed type 2 diabetes were enrolled. Short-term intensive insulin therapy was carried out using insulin pump to achieve and maintain glycemic targets (FBG< 6.1 mmol/L; 2hBG< 8.0 mmol/L) for 14 days, with daily eight-point capillary blood glucose profiles recorded. Patients were followed up for 1 year after discharge. RESULTS
In most subjects mean blood glucose and glycemic excursion parameters during the therapy were controlled within the normal range. Mean blood glucose was independently associated with amelioration of acute insulin response (r= -0.25, P=0.015) and 1-year remission (OR 0.12, 95% CI 0.034, 0.426), but negatively associated with more Level-1 hypoglycemia (r=-0.34, P=0.001), although major hypoglycemia was rare. Among mean blood glucose tertiles, patients in the middle (68.7%) and lower (75.0%) tertiles had higher 1-year remission rate compared with the upper tertile (32.3%, both P<0.001), while only the middle tertile didn't have increased hypoglycemia compared with the upper tertile (8.1±5.4 vs. 7.2±3.9 events/person, P=0.48). CONCLUSIONS
Stricter glycemic control during short-term intensive insulin therapy produced more remission despite self-manageable hypoglycemia. Based on glycemic parameters in the middle mean tertile, we propose new glycemic targets that are about 0.4mmol/L lower than current ones as long-term benefit outweighs short-term risks. This article is protected by copyright. All rights reserved.

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