Baseline determinants of remission of type 2 diabetes in response to short‐term insulin‐based therapy: The pivotal role of beta‐cell function
Bibliographic record
Abstract
Abstract Aim To identify baseline determinants of diabetes remission in response to short‐term insulin‐based therapy. Methods In this study, adult patients with type 2 diabetes (T2D) of less than 7 years duration were randomized to 8 weeks of treatment with (a) insulin glargine, (b) glargine + thrice‐daily lispro, or (c) glargine + twice‐daily exenatide, followed by 12 weeks of washout that enabled assessment of remission (defined as HbA1c < 6.5% after ≥ 3 months without glucose‐lowering therapy). At baseline, 8 weeks and washout, beta‐cell function was assessed with four measures: Insulin Secretion‐Sensitivity Index‐2 (ISSI‐2), insulinogenic index/Homeostatic Model Assessment for Insulin Resistance (HOMA‐IR), ΔC‐peptide 0‐120 /Δglucose 0‐120 × Matsuda and Δinsulin secretion rate (ISR) 0‐120 /Δgluc 0‐120 × Matsuda. Results Diabetes remission was achieved in 31 of 90 participants (34.4%). Compared with their peers, those who went on to remission had lower HbA1c ( P < .001) and better beta‐cell function at baseline (all four measures P ≤ .01). The non‐remission and remission groups did not otherwise differ in baseline insulin sensitivity/resistance (Matsuda, HOMA‐IR), body mass index, duration of diabetes, pretrial diabetes medications or allocated insulin‐based therapy during the trial. On logistic regression analyses, each baseline measure of beta‐cell function emerged as a significant predictor of remission (log ISSI‐2: adjusted OR 4.41 [95% CI: 1.71‐11.34]; log insulinogenic index/HOMA‐IR: 2.21 [1.26‐3.89]; log ΔC‐peptide 0‐120 /Δglucose 0‐120 × Matsuda: 1.62 [1.00‐2.64]; log ΔISR 0‐120 /Δgluc 0‐120 × Matsuda: 1.87 [1.09‐3.23]). Similarly, higher baseline ISSI‐2 tertile predicted longer time to glycaemic relapse after cessation of the insulin‐based therapy (log‐rank P = .029). Conclusion Beta‐cell function is the dominant baseline pathophysiological determinant of the likelihood of achieving remission of diabetes in response to short‐term insulin‐based therapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".