Attitudes toward diabetes affect maintenance of drug-free remission in patients with newly diagnosed type 2 diabetes after short-term continuous subcutaneous insulin infusion treatment

Abstract

Objective: Short-term intensive insulin treatment in patients with newly diagnosed type 2 diabetes can improve β-cell function and insulin sensitivity, which results in long-term remission without need for further antidiabetes medication. Patient attitudes toward their disease were assessed using the Diabetes Care Profile (DCP) tool to evaluate the potential impact on maintaining long-term remission.

Research design and methods: Newly diagnosed patients with type 2 diabetes were recruited and treated with continuous subcutaneous insulin infusion (CSII) for 2-3 weeks. They were also invited to participate in diabetes self-management intervention during hospitalization and complete a DCP questionnaire on attitudes toward diabetes at baseline and 3, 6, and 12 months after suspension of CSII.

Results: Near normoglycemia was achieved by 118 patients after short-term CSII, with 65 remaining in drug-free remission for >1 year. They had significantly better glycemic control and greater restoration of acute insulin response after CSII as well as higher educational attainment compared with patients experiencing relapse. They also achieved higher scores in positive attitude, (belief in) importance of care, care ability, self-care adherence, and less negative attitude. Differences between the two groups became greater over time. Cox proportional hazards model analysis indicated that greater self-care adherence (hazard ratio 0.184, P < 0.001) and homeostasis model assessment of insulin resistance before treatment (0.854, P = 0.053) were independent predictors for long-term remission, whereas elevated 2-h postprandial plasma glucose after CSII (1.156, P = 0.015) was a risk factor for relapse.

Conclusions: Attitudes toward diabetes affect long-term drug-free remission in newly diagnosed patients with type 2 diabetes after short-term CSII.

Figure 1

Glycemic control, BMI, and attitudes toward diabetes during follow-up in remission (black circle) vs. nonremission (gray square) group. A: Changes in HbA_1c. B: Changes in FPG. C: Changes in PPG. D: Percentages of patients achieving HbA_1c targets ≤6.5 and ≤7.0%, respectively, in remission (black bar) vs. nonremission (white bar) group. E: Changes in BMI. F: Changes in mean scores of positive attitude. G: Changes in mean scores of negative attitude. H: Changes in mean scores of care ability. I: Changes in mean scores of importance of care. J: Changes in mean scores of self-care adherence. *P < 0.05, **P < 0.01 remission vs. nonremission group. †P < 0.05, ††P < 0.01 changes from baseline survey or glycemic level after short-term CSII, remission vs. nonremission group.

Figure 1

Glycemic control, BMI, and attitudes toward diabetes during follow-up in remission (black circle) vs. nonremission (gray square) group. A: Changes in HbA_1c. B: Changes in FPG. C: Changes in PPG. D: Percentages of patients achieving HbA_1c targets ≤6.5 and ≤7.0%, respectively, in remission (black bar) vs. nonremission (white bar) group. E: Changes in BMI. F: Changes in mean scores of positive attitude. G: Changes in mean scores of negative attitude. H: Changes in mean scores of care ability. I: Changes in mean scores of importance of care. J: Changes in mean scores of self-care adherence. *P < 0.05, **P < 0.01 remission vs. nonremission group. †P < 0.05, ††P < 0.01 changes from baseline survey or glycemic level after short-term CSII, remission vs. nonremission group.

Figure 1

Glycemic control, BMI, and attitudes toward diabetes during follow-up in remission (black circle) vs. nonremission (gray square) group. A: Changes in HbA_1c. B: Changes in FPG. C: Changes in PPG. D: Percentages of patients achieving HbA_1c targets ≤6.5 and ≤7.0%, respectively, in remission (black bar) vs. nonremission (white bar) group. E: Changes in BMI. F: Changes in mean scores of positive attitude. G: Changes in mean scores of negative attitude. H: Changes in mean scores of care ability. I: Changes in mean scores of importance of care. J: Changes in mean scores of self-care adherence. *P < 0.05, **P < 0.01 remission vs. nonremission group. †P < 0.05, ††P < 0.01 changes from baseline survey or glycemic level after short-term CSII, remission vs. nonremission group.