Individuals with or without a FH of T2DM have been shown to have different pathophysiological characteristics during disease progression (15)
Individuals with or without a FH of T2DM have been shown to have different pathophysiological characteristics during disease progression (15). the patients achieved excellent blood glucose control in 6.23.6 days, without severe adverse effects. In the DM groups, the fasting insulin level and HOMA2-IR were lower, while the HOMA2-% and first-phase peak ratio were higher, when compared with the values prior to treatment, particularly in the FH- DM group. The HOMA2-% in the FH+ DM group was lower compared with the FH- DM group (P=0.027). Therefore, T2DM patients with and without a FH of the disease were shown to have a good response to CSII in the improvement of insulin resistance and -cell function; however, the improvements were less significant in patients with a FH compared with patients without a FH of diabetes. Keywords:type 2 diabetes, rigorous insulin therapy, family B2M history, -cell function, first-phase insulin secretion, insulin resistance == Introduction == The natural course of type 2 diabetes mellitus (T2DM) is usually longer than that observed in the medical center, and consists of progression from normal glucose tolerance (NGT) to impaired glucose tolerance (IGT), ultimately leading to T2DM. Among individuals with hyperglycemia, early insulin secretion has been shown to decrease by 27% from NGT to IGT, and decrease ASC-J9 by an additional 51% from IGT to T2DM (1). Progressive deterioration of pancreatic -cell function and the worsening of hyperglycemia over time are the basic characteristics of T2DM. Intensive insulin treatment (IIT) can decrease the endogenous secretory demand on -cells, which may lead to the recovery of -cell function and possibly prevent further loss of -cell mass (2,3). A series of studies have confirmed that the early implementation of IIT can markedly improve -cell function in the majority of patients with newly diagnosed T2DM (46). Furthermore, the early recovery of -cell function and glycemic control through IIT enhances unsatisfactory metabolic outcomes and reduces the risk of diabetic complications (7,8). In the Steno-2 study and UK Prospective Diabetes Study, patients exhibiting near-normal glycemic control from your diagnosis of T2DM were reported to have a lower long-term cardiovascular mortality rate compared with patients with worse initial control (9,10). ASC-J9 However, the mechanisms responsible for this disease-modifying effect remain unclear. It is well recognized that impaired first-phase insulin secretion is an early marker of -cell dysfunction, and also an independent and additive ASC-J9 predictor of the progression of diabetes. At present, glucotoxicity is considered to restrict first-phase insulin secretion, leading to decreased second-phase insulin secretion and potentially an increased rate of -cell apoptosis (11,12). Full or partial recovery of first-phase insulin secretion may aid long-term maintenance of good glycemic control. Wenget alpreviously reported that first-phase insulin secretion was partially restored following the completion of rigorous therapy, and the improvement in -cell function was associated with the persistence of euglycemia for one 12 months (13). T2DM is usually a multi-factorial disease associated with several possible risk factors, including life style, increasing age, insulin resistance, family history (FH) of diabetes and ethnicity. FH is known to be an important independent risk factor for T2DM, and is ascribed to shared genes and a shared environment (14,15). The probability of developing T2DM is usually two to four fold higher for individuals with a positive FH compared with those without, depending on the quantity of affected family members and their relationship to the patient (1618). However, the affected degree and exact mechanism are not obvious. In the present prospective study, the differences in first-phase insulin secretion and the effect of ITT around the improvement of -cell function were investigated and compared in newly diagnosed T2DM patients with or without a FH of diabetes. == Materials and methods == == Patients == Patients with newly diagnosed T2DM were recruited from outpatient and inpatient clinics of the ASC-J9 Department of Endocrinology at the Affiliated Hospital of Medical College, Qingdao University or college (Qingdao, China), between January 2011 and January 2013. In total, 360 patients were screened for enrollment. Of those patients, 307 patients met the inclusion criteria and were personally interviewed, with 300 patients ultimately enrolled in the study. Patients were divided into two ASC-J9 groups according to their FH of diabetes. A total of 95 patients comprised the positive FH group (FH+ DM group), while the remaining 205 patients participated in negative FH group (FH- DM group). A positive FH was defined as a direct or collateral relative with DM within three generations of the patient from the maternal.