Q J Med 2003; 96: 281-288
© 2003 Association of Physicians
Deteriorating beta-cell function in type 2 diabetes: a long-term model
From the York Health Economics Consortium, University of York, UK
Received 6 November 2002 Accepted for publication 2 January 2003.
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.
Address correspondence to A. Bagust, YHEC, Market Place, University of York, Heslington, York YO10 5NH. e-mail: ab13{at}york.ac.uk
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