| Abstract: |
This article describes a study that investigated the effect of intravenous insulin therapy combined with nicotinamide in the metabolic control and beta cell function of newly diagnosed type 1 diabetic subjects in comparison with intensive insulin therapy and nicotinamide alone. A total of 34 newly diagnosed type 1 diabetes patients were included in the pilot study. After the correction of initial metabolic disturbances, subjects were randomly assigned to one of three groups within 72 hours after admission. Twelve patients were assigned to the intensive insulin therapy plus placebo group, 11 to the intensive insulin therapy plus nicotinamide group, and 11 to the 72-hour intravenous insulin followed by intensive insulin therapy plus nicotinamide group. The subjects were monitored for 12 months. GAD antibodies, tyrosine phosphatase antibodies, and insulin autoantibodies were measured. C-peptide was measured basally and after 2, 4, 6, 8, and 10 minutes of 1 mg intravenous glucagon. Glycosylated hemoglobin (HbA1c), glucagon, and antibody measurements were determined initially and at 1, 3, 6, 9, and 12 months. The study found that HbA1c values declined to normal after treatment was initiated in all groups and remained not significantly different during the follow-up period. No differences were found between experimental and placebo groups in terms of beta cell function, considering basal or glucagon-stimulated C peptide values during the follow-up period. After pooling data from the experimental groups and comparing it with data from the placebo group, the results remained unchanged. At diagnosis, GAD positivity was observed in 10 of 12, 8 to 11, and 10 of 11 subjects in the placebo group, nicotinamide group, and the other experimental group, respectively. In addition, IA2 positivity was observed in 3 of 12, 4 of 11, and 4 of 11 subjects in the placebo group, nicotinamide group, and other experimental group, respectively. Antibody titers displayed a similar behavior in all groups during the follow-up period. The article concludes that the pilot study failed to demonstrate that the addition of 72-hour intravenous insulin and nicotinamide to the conventional intensive insulin therapy produced any beneficial effect in newly diagnosed type 1 diabetic subjects in terms of beta cell function and metabolic control. 3 figures. 1 table. 22 references. (AA-M). |