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Clinical Predictors of Progressive Beta-Cell Failure in Type 2 Diabetes
  1. Concetta Irace, PhD*,
  2. Cesare Tripolino, MD*,
  3. Claudio Carallo, MD*,
  4. Faustina Barbara Scavelli, PhD*,
  5. Elisabetta Della Valle, MD,
  6. Claudio Cortese, MD,
  7. Agostino Gnasso, MD*
  1. From the *Department of Clinical and Experimental Medicine, University Magna Græcia, Catanzaro; †Department of Public Health, Federico II University, Naples; and ‡Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
  1. Received November 5, 2014, and in revised form March 21, 2015.
  2. Accepted for publication April 7, 2015.
  3. Reprints: Agostino Gnasso, MD, Department of Clinical and Experimental Medicine, University Magna Græcia, Catanzaro Viale Europa, Località Germaneto, 88100 Catanzaro, Italy. E-mail: gnasso{at}unicz.it.

Abstract

Objectives The aim of the study was to identify factors associated with progressive beta-cell failure in a cohort of nonselected subjects with type 2 diabetes.

Methods Two hundred twenty-four medical records were evaluated. Progressive beta-cell failure was defined as the following: glycated hemoglobin is higher than 7.5% despite combined drug therapy and appropriate diet (ie, isocaloric or hypocaloric diet depending on body weight) and absence of any illness causing acute hyperglycemia. The following factors were considered as possible predictors: diabetes-related symptoms, fasting plasma glucose at the onset of disease, family history of type 2 diabetes, number of visits per year, and residency. Further potential predictors were disease duration, age, body mass index, estimated glomerular filtration rate, and hypertension and/or hyperlipidemia at the enrollment in the study.

Results The prevalence of beta-cell failure was 41%. Independent predictors of failure were longer disease duration (hazard ratio [HR] for each year of diabetes, 1.03; confidence intervals (CIs), 1.01–1.05; P = 0.03), history of hypertension (HR, 1.90; CIs, 1.73–2.89; P = 0.04), hyperlipidemia (HR, 1.65; CIs, 1.06–2.58; P = 0.03), residence in suburb (HR, 1.78; CIs, 1.06–3.01; P = 0.03), and presence of symptoms at the onset of disease (HR, 2.47; CIs, 1.51–4.03; P = 0.0001).

Conclusions Patients with long disease duration, hypertension, and hyperlipidemia who are residents in suburbs and had diabetes-related symptoms at diagnosis might deserve intensive treatment to obtain adequate and stable glycemic control.

Key Words
  • diabetes
  • beta cell
  • secondary failure
  • symptoms
  • oral hypoglycemic agent

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