Association Between Insulin Resistance and Beta Cell Function With HbA1C in Diabetics

Cross-Sectional Study on Association Between the Estimation of Insulin Resistance and Beta Cell Function Through Homeostasis Model Assessment With HbA1C Among Oral Anti-Diabetics Treatment Non-Responders

Progression of T2DM is widely accepted to be contributed by two main components: beta cell function deterioration where insulin secretion is impaired and insulin resistance where insulin physiological response is reduced. Insulin resistance and beta cell function will be estimated through a mathematical model, homeostasis model assessment. Fasting insulin and C-peptide will be measured using liquid chromatography tandem mass spectrometry. Insulin resistance and beta cell function is then compared with the glycaemic control, HbA1C.

Primary objective

• To investigate the association between the estimation of insulin resistance and beta cell function through homeostasis model assessment with HbA1C among oral anti-diabetics treatment non-responder.

Secondary Objectives

• To compare the insulin resistance and beta cell function between the OAD treatment responders (negative control) and non-responders
• To investigate the relationship between plasma level of metformin and gliclazide with the estimation of beta cell function and insulin resistance
• To identify the proportion of patients with high insulin resistance and proportion of patients with low beta cell function
• To identify difference in insulin resistance and beta cell function of different ethnic groups in Sarawak
• To compare insulin resistance with cardiovascular disease risk using Framingham Risk Score and ASCVD risk estimation

Inclusion Criteria:

• Previously diagnosed to have T2DM, currently treated with oral anti-diabetics agents (either on maximum dose of Metformin only or with maximum dose of Gliclazide) for at least 3 months with no change in medications and dosage during the period of 3 months

Exclusion Criteria:

• Patient that is on exogenous insulin, is on hormone replacement therapy or any steroids medications, with renal impairment with creatinine clearance less than 30ml/min and unable to provide informed consent