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[IP] pump therapy and Type 2 study

 <A HREF="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12519325&dopt=Abstract">Entrez-PubMed</A> 

Diabet Med 2003 Jan;20(1):76-9  <A HREF="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Display&dopt=pubmed_pubmed&from_uid=12519325">Related Articles,</A> >Links</A>     

Treatment with intravenous insulin followed by continuous subcutaneous 
insulin infusion improves glycaemic control in severely resistant Type 2 
diabetic patients.

Pouwels MJ, Tack CJ, Hermus AR, Lutterman JA.

Divisions of General Internal Medicine and Endocrinology, Department of 
Medicine, University Medical Centre Nijmegen, Nijmegen, The Netherlands.

AIMS: Despite high-dose s.c. insulin therapy, some Type 2 diabetes mellitus 
(DM) patients remain in poor metabolic control. We investigated whether a 
period of euglycaemia using i.v. insulin, followed by continuous subcutaneous 
insulin infusion (CSII), would ameliorate the deleterious effects of 
hyperglycaemia on insulin sensitivity and result in sustained, improved 
metabolic control. METHODS: In a prospective observational study, eight Type 
2 DM patients with severe insulin resistance (insulin dose 1.92 +/- 0.66 U/kg 
per day (mean +/-sd)), in poor metabolic control (HbA1c 12.0 +/- 1.7%), were 
treated with i.v. insulin for 31 +/- 10 days aimed at euglycaemia, followed 
by CSII therapy for 12 months, using insulin lispro. Before and after 28 +/- 
6 days of i.v. insulin treatment, insulin sensitivity was measured by a 
hyperinsulinaemic euglycaemic clamp. RESULTS: Euglycaemia was reached after 
12 +/- 6 days of i.v. insulin treatment. Subsequently, the i.v. insulin dose 
required to maintain euglycaemia decreased from 1.7 +/- 0.9 to 1.1 +/- 0.6 
U/kg per day (P < 0.005). Whole body glucose uptake increased from 12.7 +/- 
5.7 to 22.4 +/- 8.8 micro mol/kg per min (P < 0.0005). HbA1c decreased to 8.9 
+/- 1.2% after 28 +/- 6 days, to 7.1 +/- 0.6% after 6 months and to 8.3 +/- 
1.4% after 12 months (P < 0.001 vs. pretreatment, for all). Lipid profile 
improved and plasminogen activator inhibitor type 1 levels decreased 
significantly. Mean body weight did not change. CONCLUSIONS: In Type 2 
diabetic patients, who are poorly controlled despite high-dose s.c. insulin 
treatment, a period of 2 weeks of euglycaemia achieved by i.v. insulin 
reverses hyperglycaemia-induced insulin resistance and substantially improves 
metabolic control. Subsequent CSII treatment, using insulin analogues, 
appears to maintain improved metabolic control for at least 1 year. This 
approach is promising but needs further evaluation.

PMID: 12519325 [PubMed - in process]    
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