L'insulinothérapie fonctionnelle chez le diabétique de type 2 : évaluation de l'impact métabolique sur une cohorte de 46 patients diabétiques de type 2

Functional insulin therapy (FIT) has proved its efficacy in type 1 diabetes on glycemic control and improvement in quality of life. The objective of this study is to demonstrate the effectiveness of FIT on glycemic control in type 2 diabetes (T2D), and to assess its impact on metabolic parameters (hypoglycemia, weight, and calorie intake). This is a multivariate retrospective study of 46 patients with T2D on mixed (insulin ± oral antidiabetic drug) treatment failure, transferred to FIT. The annual assessment to the day hospital had as evaluation criteria: HbA1c, number of hypoglycemic episodes, total insulin dose, weight, and daily calorice intake. Mean age was 54.3 years, mean diabetes duration 18.7 years, and mean BMI 29.7 kg/m2. Mean HbA1c was 9.37%. After a mean follow-up of 15.7 months, we objectified a 1.51% decrease in HbA1c (P<0.001), a 1.47 per week reduction in hypoglycemia (P=0.63), a 0.16 IU/kg/d increase of the total insulin dose (P=0.43), and 3.1 kg weight gain (P=0.0013), with a 321 kcal/d reduction in the average calorie intake (P=0.04). The analysis by subgroup: patients 'good responders” with HbA1c ≤7.5% (n=20) vs. patients 'low responders” with HbA1c >7.5% (n=26) showed a metabolic advantage in good responders vs. 'low responders” in terms respectively of lower HbA1c (−1.71% vs. −1.1%; P<0.005), fewer hypoglycemic episodes (−1.8 vs. - 0.38/week; P=0.018), lower increase in total insulin doses (−0.03 vs. +0.14 IU/kg/d; P=0.067), and weight (+2.7 vs. +4.9 kg; P=0.002), but with a smaller decline in calorie intake (−221 vs. - 340 kcal/d; P=0.05). FIT in T2D patients improved glycemic control without increasing the frequency of hypoglycemia. Weight gain has to be confronted with the initial glycemic control and the benefit obtained in terms of HbA1c. It contrasts with the reduction in caloric intake despite food freedom offered by this mode of therapy.