INSULIN-TREATMENT IN TYPE-II DIABETES - T HE USEFULNESS OF THE BREAKFAST

BACKGROUND: Insulin treatment in patients with type II diabetes mellit us (DMII) is normally undertaken by clinical criteria. The aim of the present was to study the efficacy of a standard mixed meal (breakfast test) to predict the need for insulinotherapy to thereby evaluate whet her it is possible to obtain more objective criteria for the indicatio n of insulin treatment. METHODS: Fifty-six patients with DMII were stu died to evaluate the need for insulinotheapy over a one year period. S erum glucose and basal C peptide and their maximum values were determi ned In all the patients following stimulation with the breakfast test Insulin treatment was initiated according to exclusively clinical crit eria during admission. The patients were followed as out patients for a minimum of 3 months. Treatment at the end of follow up (insulin or n o insulin) was evaluated and the results of the test were retrospectiv ely analyzed. RESULTS: The basal C peptide (BCP) values were significa ntly lower In the individuals requiring insulin in comparison to those who did not require Insulin (($) over bar +/- SD 0.64 +/- 0.28 versus 1.18 +/- 0.41 nmol/l, p < 0.0001) similar to what was found with the stimulated maximum C peptide values (MCP) (1.48 +/- 0.77 versus 2.49 /- 0.63 nmol/l, p < 0.0001). On considering a BCP of less than 0.9 nmo l/l for the patients with insulin treatment the sensitivity of BCP was 83.6% and the specificity 78.9%. For a BCP value of less than 1.9 nmo l/l sensitivity was 77.7% and specificity 78.9%. Using the values toge ther, sensitivity was 66.6% and specificity 84.4%. Conclusions: The br eakfast test Is useful to Indicate the need for Insulinotherapy in pat ients with type II diabetes mellitus but is not more useful than a det ermination of isolated basal C peptide.