Application of IRI Response to Oral Glucose Loading for the Selection of the Diabetic Treatment

Abstract

In 129 patients with diabetes mellitus (64 obese patients and 65 non-obese patients), measurements were made befcrc treatment was begun of blood sugar concentrations as well as the immuno-reactive insulin (IRI) concentrations in plasma before and 30, 60, 90, 120, 180 and 240 minutes after oral loading of 50g glucose. The patterns of IRI response to oral glucose loading were divided into two types based upon the values of the sum of IRI concentrations before and after the loading the delayed response with ΣIRI over 101 and the low response with ΣIRI under 100.
All of the patients were treated in the out-patient clinic of Tenri Hospital for over 6 months, and the effects of diabetic treatment were investigated in relation to body weight, level of fasting blood sugar, and the IRI response measured before the treatment. The results revealed a close relation between the effects of the treatment and these three factors. Moreover, in order to obtain a plan for the selection of diabetic treatment, the relation between the mode of treatment (diet, sulfonyl urea, and insulin) and the three above-mentioned factors was investigated in 80 patients who were in good control.
19 of 25 obese patients, whose fasting blood sugar was under 180mg/dl and who had shown a delayed IRI response, were in good control with the diet treatment alone. Five of 12 obese patients, whose fasting blood sugar was over 180mg/dl and who had shown a delayed IRI response, also were in good control with only the dietetic therapy, but 7 patients required treatment with sulfonyl urea. In non-obese patients with fasting blood sugar under 180mg/dl, 13 of 17 patients with a delayed IRI response were in good control with the dietetic therapy alone, while 5 of 8 patients with the low IRI response required the sulfonyl urea treatment. 15 of 16 nonobese patients with fasting blood sugar over 180 mg/dl required sulfonyl urea or insulin theraz py, regardless of the pattern of IRI response.
Thus, the following plan of diabetic treatment was made out and it was thought to be clinically useful as a guide to the treatment of diabetic patients.
Fasting blood sugar
IRI response.
Treatment.
Obese patient under 180mg/dl Delayed Diet
Obese patient over 180mg/dl Delayed Diet or Sulfonyl urea
Non-obese patient under 180mg/dl Delayed Diet
Non-obese patient under 180mg/dl Low Diet and Sulfonyl urea
Non-obese patient over 180mg/dl Delayed Diet and Sulfonyl urea or Insulin
Non-obese patient over 180mg/dl Low Diet and Sulfonyl urea or Insulin