Short duration of diabetes and disuse of sulfonylurea have any association with insulin cessation of the patients with type 2 diabetes in a clinical setting in Japan (JDDM 30)

Abstract

Type 2 diabeTes melliTus (T2DM) is characterized by defects in both insulin secretion and action. The UK Prospective Diabetes Study has reported that β-cell function deteriorates progressively over time in patients with T2DM, irrespective of lifestyle and existing pharmacological intervention [1,2]. Consequently, insulin therapy is often required to achieve good glycemic control [3] and, in fact, in the clinical setting in Japan, outpatients with T2DM are started on insulin therapy. Conversely, protraction of glycemic control without insulin therapy may be preferable for patients. However, the proportion of outpatients who were able to stop insulin therapy has not been determined, nor is there information as to which insulin treatment reg- abstract. Insulin therapy is often required to achieve good glycemic control for the patients with type 2 diabetes mellitus (T2DM), while protraction of glycemic control without insulin therapy may be preferable for patients. To determine the characteristics of and therapeutic regimen in outpatients with T2DM who were able to stop insulin therapy with satisfactory glycemic control in a real clinical practice setting in Japan by a case-control study. The present study was performed on 928 patients with T2DM who started insulin therapy in 2007. Data regarding age, sex, body mass index, duration of diabetes, HbA1c, postprandial plasma glucose, plasma fasting C-peptide immunoreactivity and treatment modality were compared between patients who were able to stop insulin therapy and those who continued with insulin. Of the 928 patients, 37 had stopped insulin therapy within 1 year. In the patients who stopped insulin therapy, the duration of diabetes was significantly shorter and the daily insulin dosage at initiation and the prevalence of sulfonylurea pretreatment significantly lower compared with patients who continued on insulin. In conclusion, almost 4% of T2DM patients were able to stop insulin therapy with satisfactory glycemic control in a real clinical practice setting in Japan. Shorter duration of diabetes and disuse of sulfonylureas prior to insulin may associate with stopping insulin therapy as a near-normoglycemic remission in outpatients with T2DM in Japan.

Perioperative C‐peptide index is associated with the status of diabetes management after pancreatectomy

“…Arai et al . 16 found that the prevalence of sulfonylurea pretreatment is significantly lower in type 2 diabetes patients who were able to stop insulin therapy after transient insulin therapy than in those who were not able to stop insulin administration. Additionally, a longer duration of sulfonylurea treatment was associated with a decline in endogenous insulin secretion 17 .…”

“…Notably, patients with a lower postoperative CPI had a higher rate of sulfonylurea use before pancreatectomy. Arai et al 16 found that the prevalence of sulfonylurea pretreatment is significantly lower in type 2 diabetes patients who were able to stop insulin therapy after transient insulin therapy than in those who were not able to stop insulin administration. Additionally, a longer duration of sulfonylurea treatment was associated with a decline in endogenous insulin secretion 17 .…”

Clinical course of different long-acting insulin therapies—glargine U100, U300, degludec, and insulin degludec/insulin aspart—among Japanese patients with type 2 diabetes: a multicenter retrospective observational study (JDDM65 study)

“…In addition, 185 of the participants (22.5%) were able to withdraw from insulin therapy within 12 months. The characteristics of that withdrawal group included short duration of diabetes and nonuse of insulin secretagogues such as sulfonylureas and glinides, the same factors as those observed in a previous study [17,18]. Insulin therapy would be expected to achieve "β-cell rest," which finally leads to the preservation and recovery of insulin secretory capacity in β-cells.…”

Utilization patterns of insulin therapy and healthcare services among Japanese insulin initiators during their first year: a descriptive analysis of administrative hospital data

“…The patient profile across groups may have differed due to these unobserved factors or information unavailable in the database. For example, previous studies have reported that age at diagnosis, disease duration, and BMI were associated with clinical outcomes [ 7 , 21 ] and that disease duration and daily insulin dosage at the initiation were associated with insulin discontinuation [ 22 ]. We recommend careful interpretation of the current findings.…”