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- Title
Insulin secretion predicts the response to therapy with exenatide plus pioglitazone, but not to basal/bolus insulin in poorly controlled T2DM patients: Results from the Qatar study.
- Authors
Migahid, Osama; Megahed, Ayman; Kamal, Dalia; Jayyousi, Amin; Abdul‐Ghani, Muhammad; DeFronzo, Ralph A.; Singh, Rajvir
- Abstract
The present study aims to identify predictors for response to combination therapy with pioglitazone plus exenatide vs basal/bolus insulin therapy in T2DM patients who are poorly controlled with maximum/near‐maximum doses of metformin plus a sulfonylurea. Participants in the Qatar study received a 75‐g OGTT with measurement of plasma glucose, insulin and C‐peptide concentration at baseline and were then randomized to receive either treatment with pioglitazone plus exenatide or basal/bolus insulin therapy for one year. Insulin secretion measured with plasma C‐peptide concentration during the OGTT was the strongest predictor of response to combination therapy (HbA1c ≤ 7.0%) with pioglitazone plus exenatide. A 54% increase in 2‐hour plasma C‐peptide concentration above the fasting level identified subjects who achieved the glycaemic goal (HbA1c < 7.0%) with 82% sensitivity and 79% specificity. Only baseline HbA1c was a predictor of response to basal/bolus insulin therapy. Thus, the increment in 2‐hour plasma C‐peptide concentration above the fasting level provides a useful tool to identify poorly controlled T2DM patients who can achieve glycaemic control without insulin therapy, and thereby, can be used to individualize antihyperglycaemic therapy in poorly controlled T2DM patients.
- Subjects
PANCREATIC beta cells; EXENATIDE; PIOGLITAZONE; METFORMIN; TYPE 2 diabetes treatment
- Publication
Diabetes, Obesity & Metabolism, 2018, Vol 20, Issue 4, p1075
- ISSN
1462-8902
- Publication type
Article
- DOI
10.1111/dom.13189