Acta Diabetologica

, Volume 53, Issue 5, pp 761–767 | Cite as

Incidence and correlated factors of beta cell failure in a 4-year follow-up of patients with type 2 diabetes: a longitudinal analysis of the BETADECLINE study

  • Carlo B. Giorda
  • Giuseppina T. Russo
  • Stefania Cercone
  • Salvatore De Cosmo
  • Antonio Nicolucci
  • Domenico Cucinotta
Original Article

Abstract

Aims

Type 2 diabetes is associated with progressive deterioration of beta cell function and loss of glycemic control, with increased morbidity and mortality from microvascular and macrovascular complications. Factors predictive of beta cell decline are needed.

Methods

We have conducted a prospective evaluation of baseline predictors of beta cell dysfunction and insulin initiation in a cohort of outpatients with type 2 diabetes receiving stable treatment with oral hypoglycemic agents or dietary intervention, over a 4-year follow-up period.

Results

Of 507 patients enrolled, 56 (10.8 %) experienced the study endpoint of initiation of insulin therapy. Univariate and multivariate Cox proportional hazard regression analyses revealed that the likelihood of initiating insulin therapy during follow-up increased with longer diabetes duration and with higher baseline values for hemoglobin A1c, fasting plasma glucose, triglycerides, proinsulin, interleukin-6, Homeostatic Model Assessment-IR and lower values for Homeostatic Model Assessment-B. The likelihood of initiating insulin therapy increased by 46 % for each 1 % increase (10.9 mmol/mol) in baseline hemoglobin A1c and by 6 % for each unit increase (1 ng/l) in baseline IL-6 level. The risk was fourfold higher in the lowest versus highest Homeostatic Model Assessment-B quartile. Treatment with metformin plus a secretagogue increased the risk by fourfold.

Conclusions

Our results show that commonly measured parameters may predict treatment failure in type 2 diabetes and suggest that early treatment with metformin plus secretagogues may foretell this failure.

Keywords

Type 2 diabetes Secondary failure Beta cell function 

Supplementary material

592_2016_868_MOESM1_ESM.docx (67 kb)
Supplementary material 1 (DOCX 19 kb)

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Copyright information

© Springer-Verlag Italia 2016

Authors and Affiliations

  • Carlo B. Giorda
    • 1
  • Giuseppina T. Russo
    • 2
  • Stefania Cercone
    • 3
  • Salvatore De Cosmo
    • 4
  • Antonio Nicolucci
    • 5
  • Domenico Cucinotta
    • 2
  1. 1.Metabolism and Diabetes Unit ASL TO5Chieri (TO)Italy
  2. 2.Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly
  3. 3.MSDRomeItaly
  4. 4.Unit of Internal Medicine, Department of Medical SciencesIRCCS Casa Sollievo Della SofferenzaSan Giovanni RotondoItaly
  5. 5.Center for Outcomes Research and Clinical Epidemiology (CORE)PescaraItaly

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