Islet β-cell function preservation by different anti-diabetic treatments in Chinese elderly patients with type 2 diabetes mellitus

doi:10.4239/wjd.v16.i2.94976

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 16, Issue 2

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (276)

All Articles published online

The chart showing PDF series, HTML series, Figures (1-2) series, Tables (1-5) series.

Item

Count

PDF

HTML

161

Figures (1-2)

Tables (1-5)

Sum=229

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

Download

Sum=36

Feb 15, 2025 (publication date) through Jan 9, 2025

Times Cited of This Article

Times Cited (0)

Journal Information of This Article

Publication Name

World Journal of Diabetes

ISSN

1948-9358

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

World J Diabetes. Feb 15, 2025; 16(2): 94976
Published online Feb 15, 2025. doi: 10.4239/wjd.v16.i2.94976

Table 1 Clinical characteristics of included participants before propensity score matching

	Insulin	OAD	Insulin + OAD	P value
Patients (n)	105	321	319	-
Men, n (%)	47 (44.8)	164 (51.1)	142 (44.5)	0.365
Age (year)	67.2 ± 5.8	69.3 ± 5.8	68.1 ± 5.8	0.269
BMI (kg/m²)	24.4 ± 3.3	24.4 ± 3.3	25.6 ± 3.8	0.289
Weight	65.9 ± 6.6	65.1 ± 7.5	68.3 ± 6.7	0.189
Waist (cm)	85.8 ± 9.7	85.7 ± 10.4	89.6 ± 10.6	0.176
SBP (mmHg)	150.1 ± 21.8	141 ± 23.3	143.2 ± 21.8	0.021
DBP (mmHg)	81.2 ± 12.5	75.6 ± 12.1	75.9 ± 12.3	0.012
Hypertension (%)	70.1	49.1	68.1	0.027
HbA1c (%)	8.6 ± 2.8	7.8 ± 2.3	9.6 ± 2.6	0.018
HDL-C (mmol/L)	1.27 ± 0.4	1.24 ± 0.35	1.23 ± 0.33	0.738
LDL-C (mmol/L)	3.72 ± 1.19	3.57 ± 0.97	3.42 ± 0.9	0.515
Total cholesterol (mmol/L)	5.7 ± 1.38	5.59 ± 1.17	5.4 ± 1.1	0.525
Triglycerides (mmol/L)	1.64 ± 1.01	1.83 ± 1.48	1.67 ± 1.01	0.018
Plasma creatinine (μmol/L)	178.43 ± 114.27	142.24 ± 88.74	265.87 ± 167.94	< 0.001
Plasma urea (mmol/L)	6.0 ± 3.8	5.7 ± 3.2	6.4 ± 3.9	0.013
eGFR [mL/(min·1.73m²)]	84.4 ± 15.2	99.5 ± 16.3	77.1 ± 17.5	0.011
Fasting glucose (mmol/L)	8.34 ± 2.69	6.91 ± 2.9	9.1 ± 4.3	0.023
Fasting insulin (pmol/L)	51.2 (30.3-91.9)	55.6 (30.5-92.7)	53.3 (23.1-93.0)	0.712
Fasting c peptide (nmol/L)	0.64 (0.46-1.0)	0.8 (0.5-1.12)	0.58 (0.4-0.88)	0.002
Postprandial glucose (mmol/L)	11.8 ± 4.9	12.2 ± 4.5	13.6 ± 5.3	0.019
Postprandial insulin (pmol/L)	152.6 (70.2-305)	184.5 (90.2-351.9)	128.3 (68.4-318.9)	0.036
Postprandial c peptide (nmol/L)	1.48 (0.78-1.89)	1.79 (1.18-2.59)	1.2 (0.68-1.78)	< 0.001
Log HOMA-β	5.48 ± 0.17	5.98 ± 0.08	5.49 ± 0.08	0.019
Log HOMA-IR	2.66 ± 0.13	2.78 ± 0.08	2.76 ± 0.07	0.625
Diabetic nephrology, n (%)	20 (19.0)	99 (30.8)	102 (31.9)
Diabetic retinopathy, n (%)	15 (14.2)	45 (14.0)	77 (24.1)
Diabetic neuropathy, n (%)	25 (23.8)	71 (22.1)	82 (25.7)
Any diabetic vascular disease, n (%)	35 (33.3)	156 (48.6)	150 (47.0)

Data were presented as percent, mean ± SD or median with interquartile range. P value was derived from the χ² test, One-Way ANOVA or Kruskal-Waillis test. OAD: Oral anti-diabetes drugs; BMI: Body mass index; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; HbA1c: Glycosylated hemoglobin; HDL-C: high-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; HOMA-β: Homeostasis Model for β-cell function; HOMA-IR: Homeostasis Model for Insulin Resistance.

Table 2 Clinical characteristics of included participants after propensity score matching

	OAD vs insulin			OAD vs insulin + OAD			Insulin vs insulin + OAD
	Insulin	OAD	P value	Insulin	Insulin + OAD	P value	OAD	Insulin + OAD	P value
Patients (n)	96	96		189	189		88	88
Men, n (%)	44 (45.8)	46 (47.9)	0.772	79 (41.7)	74 (39.1)	0.601	37 (42.0)	41 (46.5)	0.544
Age (year)	58.3 ± 4.8	57.3 ± 5.5	0.484	60.2 ± 13.4	59.1 ± 12.8	0.755	58.1 ± 4.8	59.3 ± 4.4	0.526
BMI (kg/m²)	23.4 ± 2.3	23.0 ± 3.3	0.448	24.6 ± 4.6	25.1 ±4.2	0.788	24.2 ± 3.5	24.9 ± 3.6	0.852
Weight	65.1 ± 7.5	65.9 ± 6.6	0.596	65.3 ± 6.7	64.8 ± 6.6	0.458	68.3 ± 6.7	65.1 ± 7.5	0.336
Waist (cm)	84.7 ± 11.4	85.2 ± 10.7	0.234	86.6 ± 9.6	87.4 ± 10.7	0.635	88.6 ± 11.6	89.7 ± 10.5	0.452
SBP (mmHg)	140 ± 22.3	138.1 ± 22.8	0.288	137.3 ± 24.1	139.1 ± 20.2	0.189	140.2 ± 23.2	139 ± 19.3	0.793
DBP (mmHg)	81.6 ± 12.1	81.2 ± 11.5	0.938	78.5 ± 12.5	79.2 ± 11.2	0.171	81.9 ± 12.3	81.6 ± 10.1	0.549
Hypertension (%)	43.7	36.4	0.501	39.7	40.7	0.842	42	39.8	0.891
HbA1c (%)	8.9± 2.3	8.6 ± 2.2	0.238	9.40 ± 2.19	9.43 ± 2.3	0.869	9.4 ± 3.9	9.6 ± 3.5	0.384
HDL-C (mmol/L)	1.34 ± 0.51	1.37 ± 0.43	0.663	1.25 ± 0.36	1.25 ± 0.46	0.325	1.33 ± 0.75	1.31 ± 0.66	0.874
LDL-C (mmol/L)	3.47 ± 0.88	3.42 ± 1.09	0.236	3.62 ± 0.99	3.832 ± 1.19	0.331	3.44 ± 1.15	3.67 ± 1.36	0.589
Total cholesterol (mmol/L)	5.44 ± 1.08	5.41 ± 1.42	0.132	5.66 ± 1.21	5.71 ± 1.39	0.265	5.51 ± 1.06	5.69 ± 1.09	0.874
Triglycerides (mmol/L)	1.63 ± 1.33	1.69 ± 1.21	0.785	1.88 ± 1.11	1.89 ± 1.25	0.836	1.77 ± 1.36	1.98 ± 1.48	0.458
Plasma creatinine (μmol/L)	136.24 ± 87.6	148.43 ± 110.6	0.321	185.87 ± 95.4	198.43 ± 104.3	0.451	165.87 ± 76.6	162.24 ± 88.6	0.541
Plasma urea (mmol/L)	5.61 ± 1.3	5.66 ± 1.8	0.654	6.53 ± 1.9	6.36 ± 1.7	0.546	5.89 ± 2.0	6.32 ± 2.6	0.359
eGFR [mL/(min·1.73m²)]	101.5 ± 12.4	97.4 ± 13.6	0.213	84.5 ± 18.6	75.1 ± 17.6	0.336	88.4 ± 15.5	78.1 ± 16.4	0.125
Fasting glucose (mmol/L)	7.97 ± 2.13	7.89 ± 2.47	0.365	8.56 ± 3.02	8.61 ± 3.00	0.836	8.64 ± 2.15	9.27 ± 3.13	0.381
Fasting insulin (pmol/L)	60.6 (36.5-65.7)	57.2 (29.3-75.9)	0.817	59.3 (33.1-69.0)	65.2 (36.3-69.9)	0.938	60.3 (31-68)	66.6 (29.5-68.7)	0.918
Fasting c peptide (nmol/L)	0.73 (0.54-0.86)	0.77 (0.50-1.07)	0.544	0.72 (0.50-0.90)	0.68 (0.47-0.88)	0.541	0.73 (0.51-0.85)	0.67 (0.45-0.79)	0.496
Postprandial glucose (mmol/L)	12.3 ± 4.7	12.2 ± 4.1	0.847	13.3 ± 5.3	13.3 ± 4.9	0.981	13.6 ± 5.3	14.0 ± 4.5	0.977
Postprandial insulin (pmol/L)	232.5 (123.2-232.9)	232.6 (131.2-254)	0.501	222.3 (111-238.9)	222.6 (97.2-225)	0.403	194.3 (121.4-194.9)	194.5 (66.2-194.9)	0.411
Postprandial c peptide (nmol/L)	1.79 (0.98-0.91)	1.69 (1.11-2.38)	0.298	1.62 (1.03-1.93)	1.43 (0.82-1.81)	0.089	1.41 (0.86-1.71)	1.36 (0.75-1.87)	0.58
Log HOMA-β	5.60 ± 77	5.57 ± 0.91	0.864	5.41 ± 0.86	5.43 ± 0.84	0.991	5.31 ± 0.72	5.17 ± 0.91	0.277
Log HOMA-IR	2.63 ± 0.79	2.60 ± 0.91	0.866	2.69 ± 0.91	2.67 ± 0.78	0.906	2.65 ± 0.82	2.71 ± 0.75	0.511
Diabetic nephrology, n (%)	20 (20.8)	21 (21.8)	0.887	63 (0.33)	56 (0.29)	0.575	15 (17.1)	27 (30.6)	0.095
Diabetic retinopathy, n (%)	14 (14.6)	11 (11.4)	0.572	34 (0.18)	46 (0.24)	0.223	13 (14.7)	21 (23.8)	0.201
Diabetic neuropathy, n (%)	23 (23.9)	20 (20.8)	0.679	42 (0.22)	50 (0.26)	0.455	23 (26.1)	24(27.3)	0.896
Any diabetic vascular disease, n (%)	35 (36.4)	40 (41.6)	0.624	95 (0.50)	94 (0.49)	0.956	30 (34.1)	38 (43.1)	0.409

Table 3 Comparisons of β-cell function before and after anti-diabetic treatments

	Insulin	OAD	Insulin + OAD	P value
Fasting glucose (mmol/L)
Before	8.34 ± 2.69	6.91 ± 2.9	9.11 ± 4.3	0.023
After	7.62 ± 3.18	6.39 ± 2.7	7.99 ± 3.3	< 0.001
P value	0.876	0.941	0.475
Postprandial glucose (mmol/L)
Before	11.8 ± 4.9	12.2 ± 4.5	13.6 ± 5.3	0.019
After	12.6 ± 5.7	11.7 ± 3.9	12.7 ± 5.2	0.009
P value	0.295	0.975	0.169
HbA1c (%)
Before	8.6 ± 2.8	7.8 ± 2.3	9.6 ± 2.6	0.018
After	8.1 ± 2.2	7.7 ± 2.0	9.2 ± 2.3	< 0.001
P value	0.047	0.024	0.246
AUC glucose (mmol/L/h)
Before	43.5 (35.8-50.1)	40.5 (32.3-49.6)	46.6 (35.2-57.3)	0.031
After	42.6 (30.6-52.8)	39.5 (33.1-48.6)	45.3 (35.0-60.2)	0.003
P value	0.621	0.758	0.384
Fasting C peptide (nmol/L/h)
Before	0.64 (0.46-1.0)	0.8 (0.5-1.12)	0.58 (0.4-0.88)	0.002
After	0.51 (0.37-0.79)	0.71 (0.63-1.24)	0.47 (0.35-0.79)	< 0.001
P value	0.002	0.026	< 0.001
AUC C peptide (nmol/L/h)
Before	4.45 (2.73-5.81)	5.52 (3.65-8.06)	3.74 (2.16-5.42)	< 0.001
After	3.85 (3.32-5.22)	4.92 (4.28-8.02)	3.1 (2.04-4.73)	< 0.001
P value	0.153	0.294	0.047
AUC C peptide/glucose
Before	0.1 (0.06-0.17)	0.14 (0.08-0.23)	0.08 (0.05-0.125)	< 0.001
After	0.08 (0.04-0.13)	0.15 (0.1-0.21)	0.07 (0.05-0.1)	< 0.001
P value	0.532	0.735	0.405

Data were presented as absolute number, mean ± SD or median with interquartile range. P value was derived from the One-Way ANOVA or Kruskal-Waillis test among the three groups. OAD: Oral anti-diabetes drugs; HbA1c: Glycosylated hemoglobin; AUC: Area under the curve.

Table 4 Changes of β-cell function after different anti-diabetic treatments according to disease duration

Treatment	Disease duration (years)	Fasting insulin (pmol/L/h)	Fasting C-peptide (nmol/L/h)	AUC insulin (pmol/L/h)	AUC C-peptide (nmol/L/h)
Ins	0-1	65.4 ± 6.6	0.88 ± 0.08	695.7 ± 105.5	5.58 ± 0.57
	1-5	104.0 ± 33.6	0.68 ± 0.05	731.0 ± 111.2	5.16 ± 0.43
	5-10	95.5 ± 28.9	0.69 ± 0.06	628.3 ± 125.0	4.22 ± 0.34
	10-20	72.6.0 ± 24.9	0.70 ± 0.07	550.6 ± 122.9	3.91 ± 0.37
	20-30	93.1 ± 31.6	0.73 ± 0.15	605.7 ± 131.7	3.68 ± 0.51
OAD	0-1	64.7 ± 5.8	0.87 ± 0.04	696.9 ± 54.6	6.14 ± 0.27
	1-5	77.0 ± 6.6	0.98 ± 0.07	761.1 ± 39.8	6.65 ± 0.25
	5-10	62.7 ± 3.4	0.88 ± 0.03	687.8 ± 40.1	6.05 ± 0.25
	10-20	98.8 ± 18.8	0.81 ± 0.03	740.1 ± 84.4	5.14 ± 0.20
	20-30	96.8 ± 26.1	1.00 ± 0.13	709.5 ± 139.4	5.74 ± 0.65
Ins + OAD	0-1	80.6 ± 13.6	0.80 ± 0.07	715.2 ± 95.9	5.12 ± 0.48
	1-5	76.6 ± 8.9	0.78 ± 0.03	597.1 ± 53.2	4.47 ± 0.23
	5-10	89.2 ± 17.3	0.66 ± 0.02	638.0 ± 92.7	3.85 ± 0.17
	10-20	84.4 ± 7.8	0.70 ± 0.05	533.9 ± 33.4	3.85 ± 0.16
	20-30	204.2 ± 93.2	0.75 ± 0.06	542.0 ± 67.6	3.94 ± 0.31
P value	0-1	0.631	0.095	0.805	0.002
	1-5	0.402	0.001	0.001	0.001
	5-10	0.369	0.001	0.002	0.001
	10-20	0.132	0.001	0.005	0.001
	20-30	0.161	0.041	0.039	0.002

Data were presented as mean ± SD. P value was derived from the One-Way ANOVA or Kruskal-Waillis test between the three groups according to similar disease durations. Ins: Insulin therapy; OAD: Oral anti-diabetes drugs; AUC: Area under the curve.

Table 5 Comparisons of β-cell response, insulin sensitivity and insulin resistance before and after different anti-diabetic treatments

	Insulin	OAD	Insulin + OAD	P value
C peptide index [ΔC30/ΔG30]
Before	0.095 (0.025-0.14)	0.103 (0.04-0.17)	0.076 (0-0.07)	0.235
After	0.125 (0.03-0.182)	0.1 (0.03-0.27)	0.067 (0.02-0.12)	< 0.001
Log HOMA-β
Before	5.92 ± 0.17	5.91 ± 0.08	5.49 ± 0.08	< 0.001
After	5.47 ± 0.11	5.73 ± 0.08	5.32 ± 0.08	< 0.001
Log HOMA-IR
Before	2.63 ± 0.13	2.68 ± 0.08	2.76 ± 0.07	0.933
After	2.89 ± 0.15	2.79 ± 0.09	2.886 ± 0.08	0.175
Matsuda index (ISI)
Before	17.89 ± 7.6	13.4 ± 3	16.24 ± 4	< 0.001
After	14.43 ± 6.1	11.9 ± 2.8	14.1 ± 11.3	< 0.001

Data were presented as mean ± SD or median with interquartile range. The value of HOMA-β and HOMA-IR were expressed by mean ± SD after log transformation. P value was derived from the One-Way ANOVA or Kruskal-Waillis test among the three groups. OAD: Oral anti-diabetes drugs; AUC: Area under the curve; HOMA-β: Homeostasis Model for β-cell function; HOMA-IR: Homeostasis Model for Insulin Resistance; ISI: Insulin sensitivity index.

Citation: Ling W, Wang YC, Huang Y, Ou YF, Jiang YC. Islet β-cell function preservation by different anti-diabetic treatments in Chinese elderly patients with type 2 diabetes mellitus. World J Diabetes 2025; 16(2): 94976
URL: https://www.wjgnet.com/1948-9358/full/v16/i2/94976.htm
DOI: https://dx.doi.org/10.4239/wjd.v16.i2.94976