Improved glycemic control in pancreatic diabetes through intensive conservative insulin therapy.

Abstract

OBJECTIVE:

The aim of this study was to evaluate the effectivity and safety of insulin therapy in patients with DM secondary to underlying chronic pancreatitis with initially inappropriate glycemic control.

METHODS:

Pancreatic DM patients treated with oral antidiabetics (OAD) or pre-mixed insulin (PMI) with HbA1c ≥7.0% were recruited. Intensive conservative insulin treatment (ICT) (Group A, n = 16) or PMI (Group B, n = 8) was introduced instead of OAD, or the initial PMI therapy was switched to ICT (Group C, n = 10). The changes in HbA1c, fasting plasma glucose, body weight and hypoglycemic events from baseline to 2 years were followed.

RESULTS:

The patients in Group A and B had been treated with oral antidiabetics for 55 ± 68 months before switching to insulin therapy. The level of HbA1c had worsened from 8.3 ± 1.5% to 9.8 ± 1.7% during this period. The ICT had reduced HbA1c significantly from 9.7 ± 1.8% to 7.6 ± 1.4% after 12 weeks, in Group A, and five patients had HbA1c<7.0%. The introduction of PMI in Group B reduced HbA1c from 10.0 ± 1.4% to 9.0 ± 0.6% by 12 weeks. None of the patients had HbA1c<7.0%. By 12 weeks, the introduction of ICT in Group C had reduced the level of HbA1c from 8.8 ± 1.7% to 7.7 ± 1.2%. Two patients reached HbA1c<7.0%. There were two severe hypoglycemic episodes during the 2 years, one-one case in Group A and B.

CONCLUSIONS:

Oral medication becomes insufficient early in pancreatic DM. Long-term improvement of glycemic control can be achieved through intensified insulin therapy and in selected cases through PMI with a low risk of hypoglycemia.

• Authors: Viktória Terzin, Róbert Takács, Csaba Lengyel, Tamás Várkonyi, Tibor Wittmann, Attila Pálinkás, László Czakó
• Journal: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] (Pancreatology) 2012 Mar-Apr Vol. 12 Issue 2 Pg. 100-3 ISSN: 1424-3911 [Electronic] Switzerland
• PMID: 22487518 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2012 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Chemical References

• Blood Glucose
• Glycated Hemoglobin A
• Hypoglycemic Agents
• Insulin, Short-Acting
• hemoglobin A1c protein, human

Topics

• Adult
• Aged
• Blood Glucose (analysis)
• Body Weight (drug effects)
• Diabetes Mellitus (blood, drug therapy, etiology)
• Drug Substitution
• Fasting
• Female
• Glycated Hemoglobin (analysis)
• Humans
• Hyperglycemia (blood, drug therapy)
• Hypoglycemia (blood, chemically induced)
• Hypoglycemic Agents (therapeutic use)
• Insulin, Short-Acting (therapeutic use)
• Male
• Middle Aged
• Pancreatitis, Chronic (blood, complications, drug therapy)