Earlier intensified insulin treatment of Type 1 diabetes and its association with long-term macrovascular and renal complications

2015 ◽  
Vol 33 (4) ◽  
pp. 463-470 ◽  
Author(s):  
B. Rathsman ◽  
M. Donner ◽  
C. Ursing ◽  
T. Nyström
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Treatment ◽  
Renal Complications ◽  
Intensified Insulin Treatment

scholarly journals Glucagon receptor antibody completely suppresses type 1 diabetes phenotype without insulin by disrupting a novel diabetogenic pathway

2015 ◽  
Vol 112 (8) ◽  
pp. 2503-2508 ◽  
Author(s):  
May-Yun Wang ◽  
Hai Yan ◽  
Zhiqing Shi ◽  
Matthew R. Evans ◽  
Xinxin Yu ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Phosphoenolpyruvate Carboxykinase ◽  
Insulin Treatment ◽  
Glucagon Secretion ◽  
Glucagon Receptor ◽  
Acute Increase ◽  
Deficient Mice ◽  
Hba1c Levels

Insulin monotherapy can neither maintain normoglycemia in type 1 diabetes (T1D) nor prevent the long-term damage indicated by elevated glycation products in blood, such as glycated hemoglobin (HbA1c). Here we find that hyperglycemia, when unaccompanied by an acute increase in insulin, enhances itself by paradoxically stimulating hyperglucagonemia. Raising glucose from 5 to 25 mM without insulin enhanced glucagon secretion ∼two- to fivefold in InR1-G9 α cells and ∼18-fold in perfused pancreata from insulin-deficient rats with T1D. Mice with T1D receiving insulin treatment paradoxically exhibited threefold higher plasma glucagon during hyperglycemic surges than during normoglycemic intervals. Blockade of glucagon action with mAb Ac, a glucagon receptor (GCGR) antagonizing antibody, maintained glucose below 100 mg/dL and HbA1c levels below 4% in insulin-deficient mice with T1D. In rodents with T1D, hyperglycemia stimulates glucagon secretion, up-regulating phosphoenolpyruvate carboxykinase and enhancing hyperglycemia. GCGR antagonism in mice with T1D normalizes glucose and HbA1c, even without insulin.

scholarly journals Complete Long-Term Recovery of  -Cell Function in Autoimmune Type 1 Diabetes After Insulin Treatment

Diabetes Care ◽  
2004 ◽  
Vol 27 (5) ◽  
pp. 1207-1208 ◽  
Author(s):  
B. Karges ◽  
I. Durinovic-Bello ◽  
E. Heinze ◽  
B. O. Boehm ◽  
K.-M. Debatin ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Treatment ◽  
Cell Function

Intensive Treatment of Type-1 Diabetes The Balance of Benefits and Risks in the DCCT/EDIC Study

2006 ◽  
Vol 00 (02) ◽  
Author(s):  
Saul Genuth
Keyword(s):  
Clinical Trial ◽  
Type 1 Diabetes ◽  
Insulin Treatment ◽  
Intensive Treatment ◽  
Diabetic Coma ◽  
Follow Up Study ◽  
Trial Testing

With the discovery of insulin in 1921 and its rapid introduction into therapy in 1922, the complexion of type-1 diabetes changed completely. From a disease that inevitably led to death in diabetic coma within a few short years, type-1 diabetes morphed into a chronic disease as, in the 1930s, diabetic retinopathy, nephropathy, and neuropathy emerged as major complications. These complications afflicted sufferers with loss of vision, renal failure, pain, amputations, and death from cardiovascular disease (CVD) after 30–40 years. There ensued a long-standing debate as to whether these complications were caused by hyperglycemia and other consequences of insufficiently normalized metabolism or were simply an intrinsic parallel manifestation of diabetes that could not be prevented by insulin therapy. This question of whether normalization of blood glucose with intensive treatment would reduce the risk of diabetic complications compared with then-conventional insulin treatment, which only minimized or eliminated symptoms resulting from glycosuria, prevented spontaneous diabetic ketoacidosis and avoided hypoglycemia, could only be definitively answered by a long-term, randomized clinical trial testing the glucose hypothesis. Thus, the Diabetes Control and Complications Trial (DCCT) emerged, followed by the Epidemiology of Diabetes Interventions and Complications (EDIC) observational follow-up study of the same cohort of research volunteer patients.

scholarly journals Metabolic control and body mass index in patients with type 1 diabetes on different insulin regimens

2004 ◽  
Vol 4 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Indira Kulenović ◽  
Senija Rasić ◽  
Mirko Grujić
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Type 1 Diabetes ◽  
Metabolic Control ◽  
Body Mass ◽  
Insulin Treatment ◽  
Mean Values ◽  
Intensified Insulin Treatment ◽  
Type 1 Dm

ABSTRACTINTRODUCTION: Without sufficient insulin treatment, acceptable level of glycoregulation, avoidance of dislipoproteinaemia and maintaince of body mass is difficult to achieve in patients with type 1 diabetes mellitus (DM). On the other hand sometimes it is difficult to prevent weight gain, endogenous hyperlipidemia and iatrogenic insulin resistance.AIM: To compare metabolic control indicators in patients with type 1 DM in patients treated conventionally to those on intensified insulin regimen.MATERIAL AND METHODS: A sample of 52 persons with type 1 DM, without late complications and long duration of the disease, was selected. Among them 19 (36.5%) persons were treated with insulin in 4 or 5 doses, and 33 (63.5%) conventionally, in 2 doses. All the participants had biochemical indicators of metabolic control determined (glycosylated Hb, fasting and postprandial glycaemia, total cholesterol, triglycerides as well as lipoprotein fractions, HDLC and LDLC), body height (BH) and weight (BW) measured, body mass index calculated (BMI) and blood pressure measured (BP).RESULTS: In the group treated conventionally we found significantly higher mean values of BMI as compared to those on intensified insulin treatment (23.2 ± 2.0 kg/m2, and 21.2 ± 1.2 kg/m2 respectively, p<0.01) and proportion of those with overweight was as well significantly higher (27.3% versus 0%, p =0.012). We noted higher mean values of systolic (134.2 ± 17.6 mmHg, versus 123.4 ± 12.7. p<0.05) and diastolic (83.2 ± 10.1, versus 74.0 ± 9.7, p<0.01) BP. Biohemical indicators of gly-coregulation were significantly worse with, at the same time, higher total dose of applied insulin (55.9 ± 8.5 IU, versus 46.3 ± 10.0 IU, p <0.01), and insulin units per kg of body weight (0.84 ± 0.11 IU/kg versus 0.77 ± 0.15 IU/kg, p<0.05).CONCLUSION: Results indicate that intensified insulin treatment is more favourable variant of treatment, by which the certain level of insulin resistance, which might be present in patients treated with two higher insulin doses, is probably reduced. Therefore it improves metabolic outputs, blood pressure values and body mass index but also may have beneficial impact to economic aspect of insulin treatment as well.

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