Background: The study was eleborated by the group of internists from the Institute for Clinical and Experimental Medicine Prague, Czechoslovakia during the period-1 March, 1985 to 1 April, 1988. The aim of this study conducted in 32 recent diabetics, was to demonstrate the effect of conventional intensified insulin therapy (IIT) on B-cell residual secretion affected in type I diabetes.
Method: B-cell residual secretion expressed by serum C-peptide(CP) concentration fasting and after 1㎎i.v. glucagon stimulation (detectability of the method 0.02pmol/ml). Study was followed up in 32 insulin-dependent diabetics treated for more than 4years with CSII or multiple injection regiment).
Results: Good control of diabetes evaluated by mean glycaemia, M-index, HbA1C and units of insulin/㎏ B.W.) was achieved in 78%, moderated in 22% and poor control in no case. Full metabolic remission (without insulin) was noted in 2 cases of 10 and 16 months duration. Partial remission with doses of insulin < 0.5i/㎏ B.W. was observed in 34%. Neither full nor partial was seen in a control group of 12 type-I diabetics treated since the diagnosis of diabetes mellitus by non-intensified insulin therapy. CP in 11 patients in partial remission (0.32±0.21 pmol/ml), is significantly higehr than in 14 others(0.13±0.13), p<0.01. CP negativity-undetectability was found in 7(58%) out of 12 control subject, and in as little as 22% in the IIT group (p<0.05).
Conclusion: IIT in the recent state exerts a longterm beneficial effect on the preservation of B-cell secretion capacity. Adequate substitution of insulin may favourbly affect further clinical course of diabetes. In out recent-onset diabetics, support to the remaining B-cell led more often, and mainly in the long run, to remission of the disease. As an excellent agent with anabolic action, insulin acts as an immunomodulator, a fact making its adequate, and at the same time, sufficient intake at the time of an ongoing immunological process affecting Langerhans islets a necessity. This observation led us to parallel use of CSII (in combination with antirejection therapy) in diabetics in the stage of organs insufficiency with combined kidney and pancreas transplantation. In these patients, we tried to support initial function of B-cell as we did in the case of recent diabetes. A beneficial effect is also exerted by timely instruction of recent-onset diabetics in self-monitoring which enhances their well-being and helps them to cope with the problems associated the disease. A mild course of diabetes and low doses of insulin administered in an acceptable manner have also a favourable psychosomatic affect on the patients at the beginning of a life-long disease.
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