Type 2 diabetes with good glycemic control have improved insulin response and lower non-esterified fatty acid level after a meal challenge

Background: Pathogenesis of type 2 diabetes (T2DM) involves defects in β-cell function with impaired first and second phase insulin response, and reduced insulin sensitivity. Diabetic dyslipidemia is an important and common risk factor for coronary heart disease (CHD). Aims: This study examined the effect of glycemic control on post prandial insulin and lipid parameters in response to a standardised meal challenge among Type 2 diabetes patients with good and poor glycemic control. Methods: We cross-sectionally studied 31 T2DM patients with good glycemic control and 32 T2DM patients with poor glycemic control. Subjects were given, after minimum 10 hours of fasting, a standard meal containing 58% fat. Fasting and serial postprandial blood samples were taken over 8 hours to determine levels of triglyceride, direct LDL-C, apoB lipoprotein, non-esterified-fatty-acid, insulin and blood glucose. Results: Post prandial NEFA was significantly higher in poor controlled diabetes patients compared to good control diabetes patients (p = 0.019), and post-hoc analysis showed significant difference from 3 hours post prandial to 4 hours post prandial, where p= 0.021. Although the difference in insulin between the 2 groups did not reach statistical significance (p =0.058), post-hoc analysis showed significant difference between the 2 groups from fasting to 1 hour post prandial (p = 0.034) despite postprandial glucose being significantly higher in poor controlled diabetes patients (p < 0.001), throughout the postprandial period. Conclusion: T2DM patients with good glycemic control have improved insulin response with lower non-esterified fatty acid.