Islet Cell Function – Its Role in the Onset and Progression of Type 2 Diabetes

Studies of the natural history of type 2 diabetes have transformed views on the nature of the condition in the last two decades.The Belfast Study is one of the earliest and most complete studies to observe the change in blood glucose control during six years of best possible management by dietary means. After the rapid initial fall from presenting blood glucose levels over 11mM, mean fasting blood glucose was maintained around 8mM for only two years before an inexorable rise occurred. By six years after diagnosis mean plasma glucose was over 10mM.This work is all the more impressive as no oral agent therapy was used during the course of the study which truly observed natural history modified only by consistent and expert dietary advice. Calculated beta cell function revealed a fall from around 30% of normal function at diagnosis to around 22% after six years.

Download Full-text

Alpha and Beta Cell Dysfunction Improves With Effective Insulin Therapy in Treatment Naive Type 2 Diabetes - a Prospective Observational Study

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.951 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A466-A466

Author(s):

Jayanthy Ramesh ◽

Ashok Chakravarthy Makineni ◽

Madhubabu Mudimela ◽

Srivalli Madhira

Keyword(s):

Type 2 Diabetes ◽

Beta Cell ◽

Insulin Therapy ◽

Islet Cell ◽

Cell Function ◽

Beta Cell Dysfunction ◽

Newly Diagnosed ◽

C Peptide ◽

Cell Dysfunction

Abstract Abstract: Type 2 diabetes mellitus is characterized by insulin resistance and progressive beta cell decline. Elevated glucagon levels and impaired incretin axis also contribute to the poor glycemic status. Early intensive glycemic control, reduces long-term vascular complications and may preserve β-cell function. Clinical studies of effect of early insulin therapy on combined alpha and beta cell function are lacking. Objective: To determine the effect of early insulin therapy on combined alpha and beta cell dysfunction (islet cell dysfunction) in newly diagnosed type 2 diabetes. Methods: 56 newly diagnosed type 2 diabetes patients, attending the endocrinology OPD at a tertiary teaching hospital were enrolled in this treatment related follow up study after institutional ethical committee clearance, conducted between May 2017 to December 2018. Patients with HbA1C > 8.5% to <12.5% (n=56) were included in the study. Metabolic (FPG, PPG, HbA1c), and Hormonal parameters (plasma glucagon levels,fasting and 2 hour mixed meal stimulated C peptide and levels) were assessed both at baseline and after 6 months of insulin treatment. Initiating dose of insulin was 0.5 U/kg/day and the dose was titrated according to FPG and 2 hr PPG in order to maintain glycemic goals as per ADA standards. Results: The study included 56 subjects with mean age of 41.24 ± 5.64 years and a mean BMI of 25.5 kg/m2. At the end of 6 months of the study, a significant reduction in the mean FPG, PPG, HbA1C were observed,[FPG (139±14.47 mg/dl), PPG (179.89 ± 19.42mg/dl),HbA1c (7.54± 0.63%)] as compared to baseline mean FPG, (216.30 ± 42.35 mg/dl),2 hour PPG (338.44 ±62.89 mg/dl), HbA1C (10.39 ± 1.56 %) (p <0.001). Baseline glucagon levels were high (197.68± 49.09 pg/ml), and were significantly reduced at 6 months of insulin therapy (107.06±49.09 pg/ml).(p <0.001). In comparison to the baseline a significant increase in both fasting (0.73±0.27 ng/ml) and stimulated c-peptide (1.54±1.02 ng/ml) (p<0.001) levels was observed at end of the study. Conclusion: Combined alpha and beta cell (Islet) dysfunction prevails in newly diagnosed T2DM. And early insulin therapy significantly improves both these defects. The documentation of this novel beneficial effect on islet cell dysfunction in our study strengthens the concept of early insulin therapy in newly diagnosed Type 2 diabetes patients.

Download Full-text

The Efficacy and Safety of Chinese Herbal Decoction in Type 2 Diabetes: A 5-Year Retrospective Study

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2016/5473015 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Jiaxing Tian ◽

Fengmei Lian ◽

Xiaotong Yu ◽

Yashan Cui ◽

Tianyu Zhao ◽

...

Keyword(s):

Islet Cell ◽

Primary Outcome ◽

Cell Function ◽

Efficacy And Safety ◽

Diabetes Therapy ◽

Chinese Herbal ◽

Herbal Decoction ◽

Hypoglycemic Action ◽

Islet Cell Function

Background. The study was designed to assess the efficacy and safety of Chinese herbal decoction in treating outpatients with T2DM.Methods. All patients enrolled received decoction for at least 6 months. The primary outcome was the control rate of HbA1c and the change in HbA1c. FPG, 2hPG, HOMA-IR, and HOMA-βwere also collected and evaluated.Results. The control rates after treatment at months 6, 12, 18, 24, 36, 48, and 60 were45.07%,52.78%,47.22%,45.83%,50.00%,57.14%, and40.00%. Multiple linear regression showed the change of HbA1c has a significant relationship with the baseline HbA1c and duration of DM and BMI (p<0.05). Both FPG and 2hPG levels significantly decreased compared to the baseline (p<0.05). Chinese herbal decoction also improved islet cell function with decreased HOMA-IR and increased HOMA-β(p<0.05). 19 and 4 subjects deactivated the antidiabetes drugs or insulin, respectively, after taking decoction. One subject developed DKD and one developed DPN, and another subject showed abnormal liver function which was irrelevant to decoction treatment.Conclusions. Chinese herbal decoction significantly enhanced the hypoglycemic action and had certain effect on protecting islet cell function. As a candidate diabetes therapy, it may reduce the use of antidiabetes drugs and slow the progression to diabetes complications.

Download Full-text