Young onset type 2 diabetic patients might be more sensitive to metformin compared to late onset type 2 diabetic patients

Abstract

It is unknown whether YOD (young onset diabetes) and LOD (late onset diabetes) require similar insulin doses for intensive insulin therapy with a metformin add-on to achieve glycemic control. We analyzed data from our two previously performed randomized, controlled open-label trials. Patients were randomized to receive either continuous subcutaneous insulin infusion (CSII) therapy or CSII combined with metformin therapy for 4 weeks. The studies concentrated on the differences in the insulin doses used for the two groups. We included 36 YOD (age < 40 yrs) and 152 LOD (age > 40 yrs) patients. YOD patients who received metformin combined with CSII therapy required significantly lower insulin doses to maintain euglycemic control compared to patients with LOD. A multivariate analysis, controlled for gender and the fasting blood concentration, was performed to determine the significance of the differences between groups, particularly with respect to the total and basal insulin doses. There was a trend toward improvement in β-cell function and insulin resistance in terms of ΔHOMA-B and ΔHOMA-IR in patients with YOD compared to those with LOD. Newly diagnosed T2D patients with YOD required significantly lower insulin doses, particularly basal insulin doses, to maintain glycemic control compared to the LOD patients.

Male Patients with Longstanding Type 2 Diabetes Have a Higher Incidence of Hypoglycemia Compared with Female Patients

“…Then, recruited subjects received 7-day CSII therapy to achieve glycemic control. CSII therapy was provided with aspart (Novo Nordisk, Bagsvaerd, Denmark) using a Medtronic insulin pump (Northridge, CA) as previously described [ 6 , 18 , 20 ]. After subjects achieved glycemic control, defined as a fasting and 2-h post prandial capillary blood glucose concentration between 6.1 and 8.0 mmol/l [ 21 ], patients were randomized 1:1 to two groups receiving: (1) 4 days of Novo Mix 30 (Novo Nordisk, Bagsværd, Denmark) followed by 2 days of Humalog Mix 50 (humalog ® Mix50™, Eli Lilly and Co., Indianapolis, IN, USA); (2) 4 days of Humalog Mix 50 followed by 2 days of Novo Mix 30.…”

“…Nearly 20% of patients using insulin pump therapy and one-fifth of patients had symptomless nocturnal hypoglycemia [ 15 ]. Studies further highlighted that older patients had high incidences of hypoglycemia [ 16 , 17 ], although we observed that newly diagnosed male and female T2D patients required similar insulin doses to maintain glycemic control [ 18 ]. The gender differences in insulin doses required to maintain euglycemic control in patients with longstanding T2D remain largely unknown.…”

Sexual Differences in response to Mid- or Low-Premixed Insulin Analogue in Patients with Type 2 Diabetes

“…The recruited subjects received CSII therapy from day 2 to day 9, as previously described [12,15,16]. Then, patients were randomly assigned 1 : 1 to 2 groups receiving (1) 4 days of Novo Mix 30 thrice daily (Novo Nordisk, Bagsvaerd, Denmark) followed by 2 days of Humalog Mix 50 thrice daily (Humalog® Mix 50™, Eli Lilly and Company, IN, USA); (2) 4 days of Humalog Mix 50 thrice daily followed by 2 days of Novo Mix 30 thrice daily.…”

“…We hence hypothesized that male and female patients may have different responses to midor low-premixed insulin analogues with regard to glycemic variations in patients with T2D. We used continuous glucose monitoring (CGM) to monitor glucose profile as CGM provides rigorous 24 h glucose profiles [11,12].…”

A View Beyond HbA1c: Role of Continuous Glucose Monitoring

“…Also, the GOLD [ 25 ] and DIAMOND [ 26 ] trials showed that among patients with type 1 DM treated with multiple daily insulin injections, the use of CGM resulted in better glycemic control than did conventional treatment. Moreover, several studies have shown that the use of CGM can improve the mean amplitude of glycemic excursion (MAGE) and result in better glycemic control in persons with type 2 DM [ 27 – 30 ]. A recent meta-analysis of randomized controlled trials conducted on the utility of real-time and retrospective CGM in patients with type 2 DM showed that CGM in these patients could reduce HbA1c levels and time spent with hypoglycemia [ 31 ].…”