INTENSIVE THERAPY IN ADULT INSULIN-DEPENDENT DIABETES-MELLITUS IS ASSOCIATED WITH IMPROVED INSULIN SENSITIVITY AND RESERVE - A RANDOMIZED, CONTROLLED, PROSPECTIVE-STUDY OVER 5 YEARS IN NEWLY-DIAGNOSED PATIENTS

Optimal blood glucose revels and normal insulin sensitivity are aims i n the treatment of insulin-dependent diabetes mellitus (IDDM). Insulin sensitivity and insulin reserve are closely interrelated. It is essen tial to know more about both of these parameters at clinical diagnosis , because their preservation may delay the occurrence of diabetes-rela ted complications. B-cell function is likely to be retained for a long er period in patients with adult onset of the disease compared with ch ildren. In this study, intensive insulin treatment was initiated in ne wly diagnosed adult patients to determine if it preserved endogenous i nsulin secretion longer than conventional therapy. Forty nine patients with newly diagnosed diabetes were carefully categorized as having ID DM according to clinical and serological criteria. They were randomize d to an intensive (I group) or conventional (C group) insulin therapy and evaluated for 5 years. Every 6 months, a check-up included glucago n-stimulated C-peptide (GSCP), hyperglycemic glucose clamp with argini ne bolus, euglycemic-hyperinsulinemic clamp, and screening for microal buminuria, retinopathy, and neuropathy. At the end of the study, hemog lobin A(1c) [HbA(1c)] was 6.3% +/- 1.9% in the I patients and 8.1% +/- 2.1% in the C patients (P < .001). Blood glucose concentrations less than 3.5 mmol/L were more frequent in the I group than in the C group (P < .05). Insulin sensitivity (M/l) and GSCP were higher in intensive ly treated patients after 5 years (M/I, I group 40 +/- 10 nmol . kg(-1 ). min(-1) pmol/L(1) v C group 21 +/- 11, P < .005; GSCP, I group 0.6 +/- 0.2 nmol/L v C group 0.19 +/- 0.11, P < .005). The prevalence of p eripheral neuropathy was significantly lower in the I group at the end of the study. In conclusion, intensive therapy is more effective in t he preservation of insulin action and reserve. In our patients, no cas e of severe hypoglycemia was observed, indicating that intensive thera py was safe in these patients. Copyright (C) 1996 by W.B. Saunders Com pany