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QJM. 2003 Apr;96(4):281-8.

Deteriorating beta-cell function in type 2 diabetes: a long-term model.

Author information

1
York Health Economics Consortium, University of York, Heslington, UK. ab13@york.ac.uk

Abstract

BACKGROUND:

Type 2 diabetes is characterized by insulin resistance and the progressive loss of islet beta-cell function. Although the former is already established at diagnosis and changes little thereafter, beta-cell function continues to decline, leading to secondary failure of anti-hyperglycaemic therapies.

AIM:

To develop a quantitative model of the process of beta-cell function decay over time, using trial data.

DESIGN:

Re-analysis of published data.

METHODS:

The results of the Belfast Diet Study were re-analysed. Assuming patients are diagnosed at different stages in the disease process, time displacement of data was used to obtain a bi-partite spline model describing loss of insulin secretion over a 6-year period.

RESULTS:

The model was developed combining two phases, in which a long slow gradual loss of beta-cell function leads to a crisis in metabolic regulation, precipitating a much more rapid decay phase. This paradigm was consistent with a previous non-linear model of beta-cell mass regulation.

DISCUSSION:

This model may have important implications for targeting appropriate therapy to patients in each phase: delaying or avoiding full clinical type 2 diabetes in the first phase; and preventing the development of diabetic complications in the second phase.

PMID:
12651972
DOI:
10.1093/qjmed/hcg040
[Indexed for MEDLINE]

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