Near-normoglycaemic remission in African-Americans with Type 2 diabetes mellitus is associated with recovery of beta cell function

Aims To prospectively determine the frequency of remission and possible mec hanism of beta cell recovery in non-Whites with Type 2 diabetes mellitus in the setting of intensive glycaemic regulation using pharmacological agents . Methods Twenty-six consecutive, newly diagnosed African-American, Type 2 di abetic patients presenting primarily for severe hyperglycaemia (31.0 +/- 12 .8 mmol/l) were followed for at least 1 year. Initial hospitalization inclu ded treatment with insulin, fluids and electrolytes. Outpatient intensive g lycaemic regulation included insulin or glibenclamide, diabetes education a nd diet that altered nutrient content. Plasma glucose and C-peptide respons es to an oral glucose tolerance test and HbA(1c) were measured at < 14, 15- 56 and 57-112 days after presentation. Remission was defined as a HbA(1c) < less than or equal to> 6.3% and fasting plasma glucose < 6.9 mmol/l, 3 mont hs after discontinuing all pharmacological agents. Results Eleven of 26 patients (42.3%) developed remission after a mean of 8 3 days of pharmacological treatment and remained in remission during follow -up for 248-479 days; one relapsed after 294 days. Fifteen patients who did not develop a remission and were followed for 168-468 days, required conti nuing pharmacological therapy to be well-controlled. (mean HbA(1c) = 7.1%). There was no significant difference in age, sex, plasma glucose at present ation, initial glycaemic regulation, final body mass index, magnitude of we ight change or pharmacological agents used for treatment between the two gr oups. Plasma C-peptide response to oral glucose was initially (< 14 days) s uppressed in all subjects and subsequently increased. The increase was sign ificantly greater in those who underwent a remission than those who did not . Neither significant weight loss nor severe hypoglycaemia was observed in either group during intensive treatment. Conclusions Forty-two per cent of newly diagnosed, unselected African-Ameri cans with Type 2 diabetes, treated intensively using pharmacological agents , education and diet developed near-normoglycaemic remission. Remission was associated with a greater recovery of glucose-stimulated insulin secretion suggesting that therapies directed at promoting beta cell recovery and pre servation are potentially useful approaches to the treatment of Type 2 diab etes mellitus.