Glucose Variability and β - Cell Response by GLP-1 Analogue added-on CSII for Patients with Poorly Controlled Type 2 Diabetes

In the poorly controlled patients with type 2 diabetes mellitus (DM), insulin therapy is the treatment of choice to control glucose levels on target. Actually, however, the general control rate is not good which is partially due to the complex etiology in type 2 DM. Glucagon-like peptide-1 (GLP-1) is secreted from enteroendocrine L cells of the intestinal mucosa and is released into the portal circulation in response to meal ingestion1 through posttranslational processing of proglucagon by prohormone convertase-1 in its secretary cells2. GLP-1 enhances insulin secretion and inhibits glucagon release in a glucose-dependent manner, prompting the development of GLP-1-based therapies for the treatment of diabetes3. GLP-1-based diabetes therapies affect glucose control through several mechanisms, including slowed gastric emptying, regulation of postprandial glucagon, reduction of food intake, and enhancement of glucose-dependent insulin secretion without the risk of hypoglycemia4. The combination with twice-daily exenatide has been shown to improve glycemic control in patients with type 2 diabetes that had been treated with basal-only insulin regimen5. But the effect of GLP-1 analogue on intensive insulin therapy for patients with type 2 DM remains unknown. To study the effect of GLP-1 analogue in insulinized type 2 DM patients, the first priority is to optimize insulin therapy. Continuous subcutaneous insulin infusion (CSII) or insulin pump is a viable choice for patients with type 1 or type 2 DM who want close-to-physiologic insulin treatment6. By means of the insulin pump therapy during hospitalization, we can optimize the sugar control profile efficiently7. We can further evaluate the clinical response under GLP-1 analogue precisely in these patients with poorly controlled type 2 DM.