PMID- 34343296
OWN - NLM
STAT- MEDLINE
DCOM- 20211228
LR  - 20221207
IS  - 1945-7197 (Electronic)
IS  - 0021-972X (Print)
IS  - 0021-972X (Linking)
VI  - 106
IP  - 12
DP  - 2021 Nov 19
TI  - Insulin Secretion Predicts the Response to Antidiabetic Therapy in Patients With 
      New-onset Diabetes.
PG  - 3497-3504
LID - 10.1210/clinem/dgab403 [doi]
AB  - CONTEXT: The results of the present study demonstrate that beta cell function in 
      newly diagnosed T2DM patients is the key predictor of response to glucose 
      lowering medications and provides a practical tool (C-Pep120 /C-Pep0) to guide 
      the choice of glucose lowering agent. OBJECTIVE: This work aims to identify 
      predictors for individualization of antidiabetic therapy in patients with 
      new-onset type 2 diabetes mellitus (T2DM). METHODS: A total of 261 drug-naive 
      participants in the Efficacy and Durability of Initial Combination Therapy for 
      Type 2 Diabetes (EDICT) study, with new-onset diabetes, were randomly assigned in 
      a single-center study to receive 1) metformin followed by glipizide and then 
      insulin glargine on failure to achieve glycated hemoglobin A1c (HbA1c) less than 
      6.5%, or 2) initial triple therapy with metformin/pioglitazone/exenatide. Each 
      patient received a 75-g oral glucose tolerance test (OGTT) prior to start of 
      therapy. Factors that predicted response to therapy were identified using the 
      area under the receiver operating characteristic curve method. RESULTS: 
      Thirty-nine patients started and maintained the treatment goal (HbA1c < 6.5%) on 
      metformin only, and did not require intensification of antihyperglycemic therapy; 
      54 patients required addition of glipizide to metformin; and 47 patients required 
      insulin addition to metformin plus glipizide for glucose control. The plasma 
      C-peptide concentration (C-Pep)120/C-Pep0 ratio during the OGTT was the strongest 
      predictor of response to therapy. Patients with a ratio less than 1.78 were more 
      likely to require insulin for glucose control, whereas patients with a ratio 
      greater than 2.65 were more likely to achieve glucose control with metformin 
      monotherapy. In patients started on initial triple therapy, the HbA1c decreased 
      independently of the C-Pep120/C-Pep0 ratio. CONCLUSION: The increase in C-Pep 
      above fasting following glucose load predicts the response to antihyperglycemic 
      therapy in patients with new-onset diabetes. C-Pep120/C-Pep0 provides a useful 
      tool for the individualization of antihyperglycemic therapy in patients with 
      new-onset T2DM.
CI  - (c) The Author(s) 2021. Published by Oxford University Press on behalf of the 
      Endocrine Society. All rights reserved. For permissions, please e-mail: 
      journals.permissions@oup.com.
FAU - Abdelgani, S
AU  - Abdelgani S
AD  - Division of Diabetes, University of Texas Health Science Center and Texas 
      Diabetes Institute, San Antonio, Texas, USA.
FAU - Puckett, C
AU  - Puckett C
AD  - Division of Diabetes, University of Texas Health Science Center and Texas 
      Diabetes Institute, San Antonio, Texas, USA.
FAU - Adams, J
AU  - Adams J
AD  - Division of Diabetes, University of Texas Health Science Center and Texas 
      Diabetes Institute, San Antonio, Texas, USA.
FAU - Triplitt, C
AU  - Triplitt C
AD  - Division of Diabetes, University of Texas Health Science Center and Texas 
      Diabetes Institute, San Antonio, Texas, USA.
FAU - DeFronzo, R A
AU  - DeFronzo RA
AUID- ORCID: 0000-0003-3839-1724
AD  - Division of Diabetes, University of Texas Health Science Center and Texas 
      Diabetes Institute, San Antonio, Texas, USA.
FAU - Abdul-Ghani, M
AU  - Abdul-Ghani M
AUID- ORCID: 0000-0003-4556-1787
AD  - Division of Diabetes, University of Texas Health Science Center and Texas 
      Diabetes Institute, San Antonio, Texas, USA.
LA  - eng
GR  - R01 DK107680/DK/NIDDK NIH HHS/United States
GR  - DK107680/DK/NIDDK NIH HHS/United States
PT  - Clinical Trial
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Clin Endocrinol Metab
JT  - The Journal of clinical endocrinology and metabolism
JID - 0375362
RN  - 0 (Biomarkers)
RN  - 0 (Blood Glucose)
RN  - 0 (C-Peptide)
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
RN  - 0 (hemoglobin A1c protein, human)
SB  - IM
MH  - Adult
MH  - Biomarkers/*blood
MH  - Blood Glucose/analysis
MH  - C-Peptide/*blood
MH  - Diabetes Mellitus, Type 2/blood/*drug therapy/pathology
MH  - Fasting
MH  - Female
MH  - Follow-Up Studies
MH  - Glycated Hemoglobin/*analysis
MH  - Humans
MH  - Hypoglycemic Agents/*therapeutic use
MH  - Insulin/*blood
MH  - *Insulin Secretion
MH  - Male
MH  - Middle Aged
MH  - Prognosis
PMC - PMC8787634
OTO - NOTNLM
OT  - glucose control
OT  - insulin secretion
OT  - type 2 diabetes
EDAT- 2021/08/04 06:00
MHDA- 2021/12/29 06:00
PMCR- 2022/08/03
CRDT- 2021/08/03 17:28
PHST- 2021/02/27 00:00 [received]
PHST- 2021/08/04 06:00 [pubmed]
PHST- 2021/12/29 06:00 [medline]
PHST- 2021/08/03 17:28 [entrez]
PHST- 2022/08/03 00:00 [pmc-release]
AID - 6338179 [pii]
AID - dgab403 [pii]
AID - 10.1210/clinem/dgab403 [doi]
PST - ppublish
SO  - J Clin Endocrinol Metab. 2021 Nov 19;106(12):3497-3504. doi: 
      10.1210/clinem/dgab403.