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Impact of acute-phase insulin secretion on glycemic variability in insulin-treated patients with type 2 diabetes

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Abstract

Aims

The association between β-cell function and glycemic variability remains to be clarified in insulin-treated patients with type 2 diabetes. Therefore, the study sought to examine the association of various indices of β-cell function with glycemic variability in Chinese insulin-treated patients with type 2 diabetes.

Methods

Glycemic variability was assessed by the coefficient of variation (CV) of glucose levels with the use of continuous glucose monitoring (CGM). Basal β-cell function was evaluated by fasting C-peptide (FCP) and the homeostasis model assessment 2 for β-cell function (HOMA2-%β). Postload β-cell function was measured by 2-hour C-peptide (2hCP) and the acute C-peptide response (ACPR) to arginine.

Results

When a cutoff value of CV ≥ 36% was used to define unstable glucose, the multivariable-adjusted odds ratios for labile glycemic control were 0.34 (95% CI 0.18–0.64) for each 1 ng/mL increase in ACPR, 0.47 (95% CI 0.27–0.81) for each 1 ng/mL increase in FCP, 0.77 (95% CI 0.61–0.97) for each 1 ng/mL increase in 2hCP, and 1.00 (95% CI 0.98–1.01) for each 1% increase in HOMA2-%β. When we further adjusted for 2hCP and HOMA2-%β in the ACPR and FCP analyses, and adjusted for ACPR or FCP in the 2hCP analyses, only ACPR but not FCP or 2hPC remained to be a significant and inverse predictor for labile glycemic control.

Conclusions

ACPR evaluated by the arginine stimulation test may be superior to other commonly used β-cell function parameters to reflect glycemic fluctuation in insulin-treated patients with type 2 diabetes.

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Abbreviations

2hCP:

2-hour C-peptide

2hPG:

2-hour plasma glucose

ACPR:

acute C-peptide response

AST:

arginine stimulation test

BMI:

body mass index

CGM:

continuous glucose monitoring

CV:

coefficient of variation

FCP:

fasting C-peptide

FPG:

fasting plasma glucose

HbA1c :

glycated hemoglobin A1c

HDL-c:

high-density lipoprotein cholesterol

HOMA2-%β:

homeostasis model assessment 2 for β-cell function

HOMA2-IR:

homeostasis model assessment 2 of insulin resistance

LDL-c:

low-density lipoprotein cholesterol

TC:

total cholesterol

TGs:

triglycerides.

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Acknowledgements

We would like to thank all the involved clinicians, nurses, and technicians for helping with the study. We are grateful to all participants for their dedication in data collection and laboratory measurements.

Authors contributions

J.Z. and G.H. conceived and designed the study. Y.S. (Y Si), Y.S. (Y Shen) and J.L. contributed to data collection, data analysis, and writing the paper. Y.S. (Y Si), L.Z. and Y.M. contributed to data analysis. W.L. and W.Z. contributed to conduction of study and data collection. X.M., Y.B. and J.Z. contributed to interpretation of data and revision of the paper. G.H. critically reviewed and edited the paper. All authors revised the paper for important intellectual content and have approved the final version.

Funding

This work was funded by the National Key R&D Program of China (2018YFC2001004), the Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support (20161430) and Shanghai Municipal Key Clinical Specialty.

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  1. These authors contributed equally: Yiming Si, Yun Shen, Jingyi Lu

Authors and Affiliations

  1. Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 200233, Shanghai, China

    Yiming Si, Yun Shen, Jingyi Lu, Xiaojing Ma, Lei Zhang, Yifei Mo, Wei Lu, Wei Zhu, Yuqian Bao & Jian Zhou

  2. Pennington Biomedical Research Center, Baton Rouge, LA, USA

    Yun Shen, Gang Hu & Jian Zhou

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  1. Yiming Si
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Si, Y., Shen, Y., Lu, J. et al. Impact of acute-phase insulin secretion on glycemic variability in insulin-treated patients with type 2 diabetes. Endocrine 68, 116–123 (2020). https://doi.org/10.1007/s12020-020-02201-y

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