Title
Evaluation of the Effects of Different Interventions on Glycemic Control in Newly-Diagnosed Type 2 Diabetic Patients
Evaluation of the Effects of Oral Anti-Hyperglycemic Agents, Multiple Daily Injections or Continuous Subcutaneous Insulin Infusion on Glycemic Control, B-Cell Function and the Remission Rate in Newly-Diagnosed Type 2 Diabetic Patients
Phase
N/ALead Sponsor
Sun Yat-Sen UniversityStudy Type
InterventionalStatus
Completed No Results PostedIndication/Condition
Type 2 Diabetes MellitusIntervention/Treatment
gliclazide insulin human sitagliptin ...Study Participants
436The purpose of this study is to investigate and evaluate the effects of different interventions (1.continuous subcutaneous insulin infusion,2.multiple daily injections, 3.anti-hyperglycemic agents) on glycemic control, B-cell function and the remission rate in newly-diagnosed type 2 diabetic patients.
ß-Cell dysfunction and decreased insulin sensitivity are the main pathophysiological defects responsible for the development of hyperglycemia. With continuous presence of insulin resistance, progressive loss of ß-cell function is the crucial defect. Hyperglycemia has deleterious effect on β-cell function, which is partially reversible by adequate glycemic control. In newly diagnosed type 2 diabetic patients with severe hyperglycemia, 2 weeks continuous subcutaneous insulin infusion (CSII) can induce adequate glycemic control with improvement of β-cell function. Nearly half of the patients can maintain euglycemia longer than 12 months by transient CSII. The improvement of β-cell function, especially the restoration of the first-phase insulin response is related to sustained euglycemia in the newly diagnosed type 2 diabetic patients. But it is unclear whether any other interventions (such as oral hypoglycemic agents and multiple daily injections) inducing optimal glycemic control in a short period of time can have the same effect. As a multicenter, open-label, randomized, parallel-group study will be needed to further prove and clarify the findings.
Patients in continuous subcutaneous insulin infusion group received Human Insulin (Novolin-R, Novo Nordisk) with an insulin pump (H-Tron Plus V100; Disetronic Medical System, Burgdorf, Switzerland);
Patients in MDI group were treated with pre-meal Novolin-R, and Human Insulin NPH (Novolin-N, Novo Nordisk) at bedtime. Initial insulin doses were 0.4-0.5 IU/kg and total daily doses were divided into 50% of basal and 50% of bolus injection in CSII group and 30%-20%-20%-30% in multiple daily insulin injection group
In oral hpoglycemic agents group, the patients with 20 kg/m2<BMI≤25kg/m2 were initiated with Gliclazide (Diamicron, Servier) 80mg Bid (maximum to 160mg Bid), the patients with 25kg/m2<BMI≤35kg/m2 were initiated with Metformin (Glucophage, BMS) 0.5 Bid (maximum to 2.0g/d), the combination of Diamicron and Glucophage was used in patients who could not achieve glycaemic control goal with one OHA or with FPG≥11.1mmol/l at randomization
Inclusion Criteria: informed consents be given before treatment the newly-diagnosed type 2 diabetic patients fasting blood glucose (FBG) level ranging from 7.0～16.7 mmol/L age ranging from 25～70 years old body mass index (BMI) ranging from20～35kg/m2 never be treated with any anti-hyperglycemic agents or anti-hyperlipidemic agents Exclusion Criteria: having any severe acute or chronic complications renal dysfunction, blood creatinine≥150µmol/L blood aminotransferase level rising up(more than 2 times of the normal level) any severe cardiac disease including congestive cardiac failure, unstable angina and myocardial infarct in 12 months serious hypertension (systolic pressure≥180mmHg and/ or diastolic pressure≥110mmHg) chronic or acute pancreatic disease severe systematic diseases or malignant tumor allergic to the drugs using in the trial any factors interfering the result female patients incline to be pregnant being treated with corticosteroid, immunosuppressing drugs or cytotoxic drugs poor compliance
