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Results for “Glycemic Control”

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At least 19 recordsLinked to original sources

PubMed1992

Glycemic control and diabetic complications.

The relationship between glycemic control and diabetic complications remains unclear. Epidemiological studies reveal that approximately 25% of diabetic individuals do not develop complications, irrespective of degree of glycemic control. Studies of genetic factors, including HLA type, capillary basement membrane thickness, genetic predisposition to hypertension, and familial clustering of diabetic complications, suggest that there is a genetic component to developing the complications of diabetes. On the other hand, clinical trials have demonstrated that the progression of early, mild background retinopathy, microalbuminuria, and parameters of nervous system function are stabilized with improved glycemic control. Other metabolic parameters, such as serum lipoprotein levels, are significantly improved with near normoglycemia. No studies to date have evaluated the effect of blood glucose control on the prevention of diabetic complications. The degree of glycemic control required to impact on diabetic complications is unknown. In addition, achieving near normoglycemia carries increased risk for severe hypoglycemia and weight gain. Further study is needed to determine the long-term benefits of blood glucose control and to weigh that against the risks of improving glycemic control. Further investigation also is needed to address the probable interrelationship of genetic factors and glycemic control on the development of diabetic complications.

Blood Glucose↗

PubMed1991

[Glycemic control and lipoprotein profile in type I diabetes mellitus].

BACKGROUND: To analyze the relation between the degree of glycemic control and the lipoprotein profile in type I diabetes mellitus. METHODS: Seventy-five diabetics were studied in whom the total glycohemoglobin (GHb), total triglycerides (TG), triglycerides of very low density lipoproteins (TG-VLDL), total cholesterol (TC), cholesterol of very low density lipoproteins (C-VLDL), cholesterol of high density lipoproteins (c-HDL), apolipoprotein AI (Apo AI) and apolipoprotein B (Apo B) were determined. Patients were classified according to their GHb: less than 9% (good glycemic control), 9-11% (moderate glycemic control) and greater than 11% (bad glycemic control). There was homogeneity in the 3 groups with regards to other variables which influenced the lipoprotein profile. RESULTS: The concentrations of TG, TG-VLDL, TC, C-VLDL and C-LDL were significantly higher in the groups of greater GHb while those of C-HDL, Apo I and Apo B were independent of the degree of glycemic control. The number of patients whose lipid profiles may be considered as atherogenic risk increases progressively in groups with greater GHb. CONCLUSIONS: In patients with type I diabetes mellitus, bad glycemic control is accompanied by decreases in TG, TC and C-LDL up to a magnitude which frequently reaches risk values for developing vascular disease. However, in these subjects, a less protector effect dependent on C-HDL is not to be expected since their concentrations are similar to those patients with good glycemic control.

Adolescent↗

PubMedDate not supplied

Diabetes health beliefs, self-care behaviors, and glycemic control among older adults with non-insulin-dependent diabetes mellitus.

This descriptive study examined the relationships between diabetes-specific health beliefs and adherence to the diabetes regimen and glycemic control in 102 older subjects with non-insulin-dependent diabetes mellitus. Health beliefs and self-care behaviors were assessed by self-report questionnaires. Glycemic control was assessed by HbA1c values. Perceived barriers to treatment were related to adherence, while perceived severity of disease was related to glycemic control. No significant associations were found between other health belief model subscales and adherence or glycemic control. Subjects not on diabetes medication had better glycemic control than those on medication. Subjects with more recently diagnosed diabetes also had better glycemic control. Practice and research attention should include older diabetic persons' perceived barriers to performing diabetes-specific self-care behaviors and perceived severity of the disease to identify potential health beliefs that may need to be altered for improving glycemic control.

Aged↗

PubMed2026

Technology choice, glycemic control and patient-reported outcome measures in adults with type 1 diabetes: A randomized crossover trial comparing a smart insulin pen with an automated insulin delivery system (EBIACE-1).

AIMS: To compare glycemic outcomes and patient-reported outcome measures (PROMs) between smart insulin pens (SIP) and an automated insulin delivery (AID) system in adults with type 1 diabetes (T1D), and to identify individuals able to maintain near-optimal glycemic control using SIP. METHODS: EBIACE-1 was a randomized, open-label, crossover trial including 31 adults with T1D. Participants received SIP (InPen™) and AID (MiniMed™ 780G) for 6 months each. Co-primary outcomes were time in range (TIR 70-180 mg/dL) and HbA1c. Treatment effects were assessed using longitudinal models in intention-to-treat (ITT) and per-protocol (PP) analyses. Predictors of near-optimal glycemic control with SIP were evaluated using multivariable logistic regression. RESULTS: AID improved glycemic control versus SIP, with higher TIR (81 % vs 66 %; +15 %, 95 % CI 10-19; P < 0.001) and lower HbA1c (6.9 % [52 mmol/mol] vs 7.3 % [56 mmol/mol]; -0.4 %, 95 % CI - 0.6 to - 0.3; P < 0.001). Near-optimal glycemic control with SIP was achieved by 12 of 26 participants (46 %). In exploratory analyses, higher baseline diabetes-related life interference was associated with a lower probability of achieving this outcome. CONCLUSIONS: AID provides superior glycemic control, although nearly half of participants achieved near-optimal control with SIP, supporting a personalized approach to technology selection.

Adult↗

PubMed1992

Influence of glycemic control on interaction of very-low- and low-density lipoproteins isolated from type I diabetic patients with human monocyte-derived macrophages.

The VLDL and LDL fractions were isolated from 29 patients with type 1 diabetes at the time of admission to the hospital to restore glycemic control and again at discharge. These lipoprotein fractions were incubated with human monocyte-derived macrophages, and the rates of macrophage CE synthesis were determined. The rates of CE synthesis in human macrophages were significantly greater (P less than 0.005) when incubated with VLDL isolated from type I diabetic patients before compared with after glycemic control was attained and averaged 1.84 +/- 0.52 and 1.09 +/- 0.27 nmol (1.20 +/- 0.34 and 0.71 +/- 0.18 micrograms) [14C]cholesteryl oleate synthesized.mg cell protein-1 x 20 h-1, respectively. In contrast, when LDL isolated from the same patient during the same period was incubated with human macrophages, the rates of cellular cholesteryl ester synthesis did not differ significantly and averaged 4.23 +/- 1.26 and 3.91 +/- 0.96 nmol (2.75 +/- 0.82 and 2.55 +/- 0.63 micrograms) [14C]cholesteryl oleate synthesized.mg-1 cell protein.20 h-1, respectively. There was a significant increase in the total cholesterol content of VLDL isolated before glycemic control compared with that isolated after glycemic control was attained (P less than 0.05) resulting from a significant increase in the FC and CE (P less than 0.05) contents of these VLDL particles. There was a significant decrease in the ratio of FC to PL in VLDL, but not LDL, isolated after glycemic control (P less than 0.05). The percentage of apoE in VLDL was significantly decreased (P less than 0.05) after glycemic control was attained.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1992

Does glycemic control of type II diabetes suffice to control diabetic dyslipidemia? A community perspective.

OBJECTIVE: To assess the extent to which glycemic control by itself results in satisfactory control of diabetic dyslipidemia. RESEARCH DESIGN AND METHODS: A population-based case series consisting of 386 Mexican Americans and 94 non-Hispanic whites with non-insulin-dependent (type II) diabetes was studied. All subjects answered questions about their medical history and care received and underwent a standardized oral glucose tolerance test and measurements of fasting serum lipid and lipoprotein concentrations. Three definitions of dyslipidemia were used: total cholesterol greater than 6.20 mM (240 mg/dl), triglyceride greater than 2.82 mM (250 mg/dl), and high-density lipoprotein cholesterol less than 0.90 mM (35 mg/dl). RESULTS: Despite having removed subjects receiving lipid-lowering drugs, diabetic subjects who had been previously diagnosed and were under medical care exhibited a lower prevalence of hypertriglyceridemia than those who were newly diagnosed at the time of their survey visit, suggesting that conventional management was associated with a reduced frequency of this dyslipidemia. Among previously diagnosed cases, the prevalence of dyslipidemia rose with worsening glycemic control but there was little association with type of therapy (diet only, oral agents, or insulin) or frequency of physician visits. In general, the prevalence of dyslipidemia in diabetic subjects remained higher than in nondiabetic subjects, despite hypoglycemic therapy. CONCLUSIONS: The results suggest that glycemic control by itself does not suffice to control diabetic dyslipidemia and that significant numbers of diabetic subjects will need direct lipid management. Clinical trials are urgently needed to define the optimum management strategy for diabetic dyslipidemia.

Adult↗

PubMedDate not supplied

Longitudinal study of a diabetes education and care intervention: predictors of improved glycemic control.

BACKGROUND: This study prospectively identifies those characteristics of office patients with diabetes that predict subsequent improvement in glycemic control in response to an educational intervention. METHODS: Data on demographic factors, disease characteristics, and glycemic control were obtained on a consecutive series of patients referred by their primary physician to a 4-day outpatient diabetes education and care program. Follow-up measurement of glycosylated hemoglobin (HbA1C) was obtained from the same laboratory 2 months later. Analysis using logistic response models identified baseline characteristics associated with improved HbA1C. RESULTS: Among the 169 study subjects, 74 (44 percent) had at least a 20 percent improvement in HbA1C levels 2 months after the program. Among these subjects, mean HbA1C level was 10.6 percent before and 7.4 percent 2 months after the program. Factors associated with improvement in HbA1C values in bivariate and multivariate logistic models included duration of diabetes less than 2 years (risk ratio = 1.90, 95 percent confidence interval (CI) 1.30-2.76) and initial HbA1C level greater than 10 percent (risk ratio = 2.75, 95 percent CI 2.08-4.01). Baseline functional status, health locus of control, social support, knowledge of diabetes self-care, age, weight as percentage of ideal body weight, age at diagnosis, race, sex, family history of diabetes, type of diabetes, and mode of treatment were not significant predictors of improved HbA1C. CONCLUSIONS: Patients with shorter duration of diabetes and poor baseline glycemic control were most likely to have clinically significant glycemic responses to this program. Severity of disease and regression to the mean were unable to account for this association, leaving unanswered the question of the mechanism of this association. The data also identified a group of patients who do not respond well to this educational approach and for whom novel approaches to behavior change should be considered.

Connecticut↗

PubMed1992

Effect of glycemic control on the overnight dexamethasone suppression test in patients with diabetes mellitus.

Because many of the clinical features associated with Cushing's syndrome are frequently found in patients with diabetes mellitus, diabetic patients are often evaluated for Cushing's syndrome. The initial test for Cushing's syndrome is the 1 mg overnight dexamethasone suppression test (DST), but its value as a screening test in diabetic subjects, especially those with poor glycemic control, has been questioned. To address this issue, an overnight DST was administered to 100 subjects with diabetes. Only 7 patients failed to suppress their plasma cortisol to less than 140 nmol/L (5.0 micrograms/dL), achieving a specificity of 93%. There was no relation between acute glycemic control (as measured by the mean of 4 serum glucose values obtained before receiving dexamethasone) or chronic glycemic control (as measured by glycohemoglobin) and false positive responses to the 1 mg overnight DST. The mean of the measures of acute glycemic control of the 7 subjects who had false positive results, 14.4 +/- 2.8 mmol/L, was not significantly different than that of the 93 subjects with normal responses, 13.2 +/- 3.3 mmol/L. Similarly, the mean glycohemoglobin of the subjects with false positive results, 12.8 +/- 2.4%, was not significantly different than that of the subjects with normal responses, 12.9 +/- 2.5%. There was no correlation between plasma cortisol after dexamethasone and glycohemoglobin (r = 0.05), and only a weak correlation with the mean serum glucose (r = 0.21). We conclude that the 1 mg overnight DST is a valid screening test for Cushing's syndrome in patients with diabetes, regardless of glycemic control.

Adult↗

PubMed1992

Stress buffering and glycemic control. The role of coping styles.

OBJECTIVE: To test the hypotheses that chronic psychosocial stress is associated with worse glycemic control and that coping moderates (buffers) this effect. RESEARCH DESIGN AND METHODS: Subjects consisted of 105 insulin-treated adults from the Diabetes Division of Henry Ford Hospital who filled out questionnaires on stress and coping and received an HbA1 test at a clinic appointment. Six coping styles were examined, including both emotion- and problem-focused styles. Two standardized stress inventories were administered. Ineffective coping was defined as scoring below the median for stress-dampening coping styles and above the median for stress-exacerbating styles. RESULTS: Stress was significantly (P less than 0.05) correlated with higher HbA1 in all but one ineffective coping subgroup. Conversely, none of 12 correlations between stress and glycemic control was significant in the effective coping subgroups. CONCLUSIONS: Chronic psychosocial stress is associated with worse glycemic control among those who do not cope effectively with stress. Effective coping can protect individuals from the deleterious effects of stress.

Adaptation, Psychological↗

PubMed1992

Glycosylated serum protein levels assayed with highly sensitive immunoradiometric assay accurately reflect glycemic control of diabetic patients.

OBJECTIVE: To develop a sensitive and reliable immunoreadiometric assay to measure glycosylated lysine residues on serum proteins (GSP) and to evaluate its efficacy in monitoring glycemic control. RESEARCH DESIGN: The effect of acute and chronic in vitro and in vivo changes in glucose levels on GSP concentration was evaluated. GSP determinations from insulin-dependent diabetic (IDDM) patients, non-insulin-dependent diabetic (NIDDM) patients, and control subjects were correlated with other indices of glycemic control. RESULTS: The GSP levels were unaffected by acute glucose changes after food or intravenous glucose administration but increased during storage at -20 degrees C due to in vitro glycosylation by endogenous glucose. Immediate acidification of the serum prevented this, permitting long-term storage despite high ambient glucose levels. In randomly selected diabetic patients, 96% of GSP values were greater than the mean +3SD of nondiabetic control subjects. In diabetic patients, GSP levels correlated with mean plasma glucose concentrations (Kendall correlation statistics 0.47, P less than 0.001), fasting plasma glucose levels (Kendall statistics 0.42, P less than 0.001), and glycosylated hemoglobin (GHb, Kendall statistics 0.30, P less than 0.005). Induction of near-normal glycemia in poorly controlled NIDDM patients reduced GSP levels with a slope consistent with a half time of disappearance of 4.7 +/- 0.4 days. GSP levels remained elevated in 6 of 10 well-controlled NIDDM patients, despite normal GHb concentrations. Chronic hypoglycemic states, like pregnancy and hyperinsulinemic hypoglycemia, were associated with significantly low GSP levels. CONCLUSION: We describe a reproducible and sensitive immunoradiometric assay for GSP that closely reflects the degree of glycemic control in diabetic patients. Further studies are needed to determine whether this assay may be useful in screening for glucose intolerance or gestational diabetes.

Blood Glucose↗

PubMed1992

Impact of associated conditions on glycemic control of NIDDM patients.

OBJECTIVE: To assess the impact of associated conditions (obesity, dyslipidemia, and hypertension) on the glycemic control of non-insulin-dependent diabetes mellitus (NIDDM) patients under home-life conditions. RESEARCH DESIGN AND METHODS: We analyzed the metabolic data of 271 NIDDM patients (89% Mexican American) screened in a population-based survey (the San Antonio Heart Study). RESULTS: Obesity was present in 77% of the patients, hypertension in 23%, hypertriglyceridemia (serum triglycerides greater than 2.9 mM) in 23%, and hypercholesterolemia (serum total cholesterol greater than 6.5 mM) in 14%. Forty percent of the patients had two or more comorbid conditions. With the use of a multiple linear regression model, which was adjusted for age, sex, ethnicity, distribution of body fat (waist-hip ratio), plasma insulin, and treatment (of both diabetes and hypertension), we found that the presence of higher serum triglyceride concentrations was associated with significantly higher plasma glucose levels both in the fasting state (1.4 mM, P less than 0.001) and 2 h after an oral glucose load (1.2 mM, P = 0.003). The presence of obesity, hypertension, or high serum cholesterol levels was not associated with significant changes in glycemic control. When the entire group was stratified by diabetes treatment (untreated n = 89, diet n = 75, oral agents n = 82, insulin n = 25) and after adjusting for age, sex, ethnicity, and waist-hip ratio, only fasting and 2-h plasma glucose and insulin concentrations were significantly different across treatment groups, with diet and oral agents being associated with higher fasting (P less than 0.001) and postglucose (P less than 0.005) plasma glucose levels and lower plasma insulin concentrations (P less than 0.005) compared with newly diagnosed patients. Neither serum lipids nor blood pressure differed across treatment. CONCLUSIONS: In NIDDM patients under home-life conditions, higher serum triglycerides are associated with higher fasting and postglucose hyperglycemia regardless of antidiabetic treatment. The presence of obesity, hypertension, or high serum cholesterol levels is not associated with significant changes in glycemic control.

Blood Glucose↗

PubMed1992

Guar gum in insulin-dependent diabetes: effects on glycemic control and serum lipoproteins.

We examined the effect of guar gum on glycemic control and serum lipid and lipoprotein profiles in mildly hypercholesterolemic patients with insulin-dependent diabetes. The study was done in a randomized, double-blind fashion with either guar gum or placebo added to the diet four times per day for 6 wk each. Fasting blood glucose and hemoglobin A1c decreased significantly during the guar-gum diet, whereas the diurnal glucose profile was unchanged. In addition, serum low-density-lipoprotein (LDL) cholesterol decreased by 20% and the ratio of LDL cholesterol to high-density-lipoprotein cholesterol by 28% during guar-gum therapy. No changes were seen in the placebo group. In conclusion, guar gum can improve glycemic control and decrease serum LDL-cholesterol concentrations in mildly hypercholesterolemic insulin-dependent diabetic patients and thus reduce risk factors for both micro- and macroangiopathic complications.

Adult↗

PubMed1992

Hypoglycemia in diabetics on dialysis with poor glycemic control: hemodialysis versus continuous ambulatory peritoneal dialysis.

Eight diabetic men with poor glycemic control, probably worsened by severe congestive heart failure and gastroparesis, were sequentially dialyzed by CAPD and hemodialysis. Mean blood glucose concentration, blood glycosylated hemoglobin, and insulin dose were higher during CAPD than during hemodialysis. Among blood glucose determinations, however, the frequency of hypoglycemia (glucose less than 3.3 mmol/L) was higher during hemodialysis (13.2 +/- 8.9%) than during CAPD (2.8 +/- 2.1% p = 0.012), whereas the frequencies of hyperglycemia (glucose greater than 11.1 mmol/L) and euglycemia (glucose between 3.5 and 11.1 mmol/l) did not differ between the two dialysis modalities. Furthermore, hypoglycemia was severe during hemodialysis and was associated with two deaths. There were no deaths linked to abnormalities in blood glucose concentration during CAPD. When hypoglycemia is frequent in diabetics with poor glycemic control, CAPD is preferable to hemodialysis.

Blood Glucose↗

PubMed1992

Effect of rapid glycemic control on progression of diabetic retinopathy.

The effect of the start of glycemic control on the progression of retinopathy was investigated by a case-control study. The changes in glycosylated hemoglobin (HbA1) were compared between a case group, diabetic cases showing progression of retinopathy (Group 1), and a control group, diabetic cases showing no progression of retinopathy (Groups 2-A and 2-B). Group 2-A was matched with Group 1 on the basis of the grade of retinopathy at the first examination and other clinical data. Group 2-B was matched with Group 1 in terms of HbA1 value and methods of control, but had no retinopathy or background retinopathy. The retrospective follow-up period for the three groups was 24 months. On the basis of the respective matching factors, Groups 1 and 2-A were divided into 9 blocks of homogeneous subjects, and Groups 1 and 2-B were similarly divided into 6 blocks. The resulting data was evaluated block by block, using the analysis of variance (ANOVA) and a conditional logistic regression analysis. In Group 1, the HbA1 value decreased rapidly 10-6 months before the progression of retinopathy, but the HbA1 value did not change in Groups 2-A and 2-B during the 24-month follow-up. The difference in the estimated mean HbA1 value between 10-9 months and 1-0 month before the progression of retinopathy was 2.46% greater in Group 1 than in Group 2-A, as determined by ANOVA. The relative risks of a 1, 2 and 3% increase in HbA1 value for 7-6 months were estimated as 1.6, 2.4 and 3.8, respectively, by conditional logistic regression analysis. These findings indicate that the decrease in HbA1 value during any 6-month period should be limited to less than 2% in order to prevent the progression of retinopathy. It is also evident that too rapid a decrease at the initiation of glycemic control could cause severe or transient exacerbation of the progression of retinopathy.

Analysis of Variance↗

PubMed1992

Effect of glycemic control on growth velocity in children with IDDM.

OBJECTIVE: To determine the effect of glycemic control on growth velocity in children with insulin-dependent diabetes mellitus. RESEARCH DESIGN AND METHODS: One hundred twenty-two children with insulin-dependent diabetes mellitus were studied over a 5-yr period. Every 4 mo, glycemic control was assessed by measuring total glycosylated hemoglobin (GHb), pubertal status was determined by physical examination, and height was measured with a stadiometer. Height measurements were normalized for age and sex by converting them to tau scores (the number of SD above or below the mean for age and sex). Alterations in growth velocity were determined by the change in tau scores (delta tau) between visits (i.e., no change in tau score = normal growth velocity; decrease in tau score = growth deceleration; and increase in tau score = growth acceleration). RESULTS: A linear relationship was seen between GHb levels and the change in tau scores (r = -0.117, P = 0.001). GHb values less than 8% were associated with growth acceleration (delta tau = +0.10 +/- 0.03), and the greatest growth deceleration occurred when GHb was greater than 16% (delta tau = -0.07 +/- 0.03). The level of GHb at which growth suppression occurred (mean delta tau became negative) was dependent on pubertal status: Tanner stage 1 greater than or equal to 10%, Tanner stages 2 and 3 greater than or equal to 8%, Tanner stages 4 and 5 greater than or equal to 16%. CONCLUSIONS: Linear growth velocity in children with insulin-dependent diabetes mellitus is heavily related to metabolic control. Children who are prepubertal or in the early stages of puberty are the most vulnerable to growth suppression. Once puberty is well established, growth suppression does not occur until marked hyperglycemia (GHb greater than 16%) exists.

Adolescent↗

PubMed1979

Serum protein-bound hexose in diabetes: the effect of glycemic control.

To determine whether the carbohydrate content of serum proteins is related to overall glycemic control, we studied serum protein-bound hexose and glycosylated hemoglobin [HbA1(a+b+c)] in 37 ambulant diabetic patients and 32 nondiabetic controls. Protein-bound hexose was correlated with HbA1(a+b+c) in the diabetic patients (r = 0.36, P less than 0.025). The mean protein-bound hexose level of the diabetic patients was greater than that of the controls (190.8 versus 174.7 mg/dl, P less than 0.01), but diabetic patients with HbA1(a+b+c) less than 12% had a mean protein-bound hexose similar to the controls. In nine of the diabetic patients, mean protein-bound hexose and HbA1(a+b+c) were significantly reduced during a period of intensive outpatient care, while two major serum glycoproteins, haptoglobins and alpha-1-antitrypsin, were unchanged. Our findings support the hypothesis that increased glycosylation of serum proteins may occur in diabetes mellitus; this abnormality in serum protein-bound hexose may be corrected by close attention to overall glycemic control.

Blood Proteins↗

PubMed1991

Uteroplacental Doppler flow velocity waveform analysis correlates poorly with glycemic control in diabetic pregnant women.

We examined 65 pregnant women with gestational (n = 31) and insulin dependent (n = 34) diabetes mellitus in order to evaluate the clinical usefulness of Doppler flow velocity waveform analysis in these pregnancies. Umbilical and uterine artery flow velocity waveforms were obtained during the third trimester with a continuous wave Doppler device. Quality of maternal glycemic control was evaluated by hemoglobin (Hb) A1 measurements at the time of delivery in 61 patients and by mean capillary blood sugars during the third trimester of pregnancy in four patients. There was no difference in various clinical and Doppler parameters between patients with good glycemic control and those with poor control. In contrast, the same clinical and Doppler parameters were significantly different in patients with preeclampsia than in those without preeclampsia, regardless of glycemic control. There was a poor positive linear correlation (r = 0.30, p less than 0.02) between maternal HbA1 and umbilical artery flow velocity waveforms (systolic/diastolic ratio). Proteinuria correlated better with umbilical artery systolic/diastolic ratio (r = 0.49, p less than 0.001). We conclude that Doppler flow velocity waveform analysis may be clinically useful only in diabetic pregnancies complicated by preeclampsia.

Adult↗

PubMed1992

Effect of conventional and intensified insulin therapy on free-insulin profiles and glycemic control in NIDDM.

OBJECTIVE: To investigate the effects on 24-h insulin and glucose profiles of two- and four-dose insulin regimens in patients with non-insulin-dependent diabetes mellitus (NIDDM) who have failed oral agent therapy. RESEARCH DESIGN AND METHODS: Ten patients with NIDDM and 10 matched nondiabetic control subjects took part in the study, a randomized crossover trial with 8-wk treatment periods. We determined 24-h profiles of blood glucose and free insulin in control subjects and patients when they were taking oral agents and at the end of each treatment period. The two-dose regimen was mixed (15% regular, 85% NPH) insulin given before breakfast and dinner, and the four-dose regimen was regular insulin given before meals and NPH given at 2200. RESULTS: Patients taking oral agents had higher mean blood glucose than control subjects (mean +/- SE 12.6 +/- 0.6 vs. 4.5 +/- 0.1 mM, P less than 0.0001) and similar 24-h insulin concentrations but lower postprandial insulin concentrations (at breakfast, 87.6 +/- 13.8 vs. 228.6 +/- 29.4 pM, P less than 0.01). Mean 24-h insulin concentrations were the same on two- and four-dose regimens, and both regimens caused basal hyperinsulinemia. Glycemic control also improved. Postprandial insulin peaks were higher at lunch and dinner on the four-dose regimen, and postprandial blood glucose was lower. Fasting proinsulin was elevated in patients compared with the control subjects (25.1 +/- 4.7 pM vs. 5.0 +/- 0.9 pM, P less than 0.001) and was suppressed to normal during insulin treatment. CONCLUSIONS: Two- and four-dose insulin regimens can achieve similar glycemic control. Both regimens cause basal hyperinsulinemia but normalize the hyperproinsulinemia observed during failure of oral agent therapy. Four-dose insulin regimens offer few advantages to the glycemic control achieved with two-dose regimens but may be more physiological.

Blood Glucose↗