Evaluating the role of time in range as a glycemic target during short‐term intensive insulin therapy in patients with newly diagnosed type 2 diabetes

Abstract

Background: Tight glycemic control during short-term intensive insulin therapy (SIIT) is critical for inducing diabetes remission in patients with newly diagnosed type 2 diabetes (T2D). This work aimed to investigate the role of time in range (TIR) during SIIT as a novel glycemic target by predicting clinical outcomes.Methods: SIIT was given to 116 patients with newly diagnosed T2D, with daily eight-point capillary glucose monitored. Glycemic targets (fasting/premeal glucose, 3.9-6.0 mmol/L; 2 h postprandial blood glucose, 3.9-7.8 mmol/ L) were achieved and maintained for 2 weeks. TIR PIR was calculated as the percentage of glucose points within these glycemic targets during the maintenance period and was compared to TIR 3.9-7.8mmol/L and TIR 3.9-10.0mmol/L . Acute insulin response (AIR), HOMA-IR, HOMA-B, and disposition index (DI) were measured. Patients were followed up for 1 year to observe clinical outcomes. Results: TIR PIR , TIR 3.9-7.8mmol/L , and TIR 3.9-10.0mmol/L were 67.2 ± 11.2%, 80.8 ± 9.2%, and 90.1 ± 6.2%, respectively. After SIIT, β-cell function and insulin sensitivity improved remarkably, and the 1-year remission rate was 55.2%. 4AIR and 4DI were positively correlated with all the TIR values, whereas only TIR PIR was correlated with 4HOMA-IR (r = À0.22, p = 0.03). Higher TIR PIR but not TIR 3.9-7.8mmol/L or TIR 3.9-10.0mmol/L was robustly associated with diabetes remission; patients in the lower TIR PIR tertile had an elevated risk of hyperglycemia relapse (hazard ratio 3.4, 95% confidence interval 1.6-7.2， p = .001). Only those with TIR PIR ≥ 65% had a one-year remission rate of over 60%. Conclusions: These findings advocate TIR PIR ≥ 65% as a novel glycemic target during SIIT for clinical decision-making.Liehua Liu, Weijian Ke, and Lijuan Xu contributed equally to the study, and should be considered joint first author.

Decreased circulating dipeptidyl peptidase-4 activity after short-term intensive insulin therapy predicts clinical outcomes in patients with newly diagnosed type 2 diabetes

“…Based on this evidence, SIIT has now been recommended by the Chinese Diabetes Society as a standard therapy for patients with newly diagnosed T2D with remarkable hyperglycemia ( 8 ). However, although several predictors of treatment response have been identified in studies, there is currently no ideal method to predict long-term response after intensive treatment ( 3 – 6 , 9 , 10 ). This is particularly critical in the determination of subsequent management and whether to initiate drug treatment as early as possible, rather than observe until hyperglycemia relapse.…”