This original research study from Jothydev’s Diabetes Research Centre was presented at the 48th Annual Meeting of the European Association for the Study of Diabetes (EASD) at Barcelona, Spain in Sep 2013.The team led by Dr.Jothydev Kesavadev is credited for this original finding.

In the natural history of progression of type 2 diabetes the initial hyperinsulinemia culminates in near total decline in the beta cell function. The eventual loss of beta cell function and associated insulin secretary deficiency is more rapid with higher HbA1c levels. In our centre, subjects registered under telemedicine based long term follow up care Diabetes Tele Management System(DTMS®) maintains near normal metabolic targets being followed up frequently via a multi disciplinary trained diabetes team. The follow up program via the telephone or internet as published elsewhere precludes physical visits to the hospital and has been proven cost effective and helps maintain HbA1c targets without significant hypoglycemia. We hypothesized the correlation between C-peptide levels, duration of diabetes, HbA1c and the effects of a long term follow up program on these parameters if subjects maintain desirable glycemic targets.

A cross-sectional analysis of 2076 T2DM patients aged above 20 years was performed. 37% were female. Mean age was 51.7 year SD 11.9 and C-peptide mean was 2.725 SD 1.7.A1c mean was 8.8 SD 2.1 829 patients with duration of follow-up more than 1 year and 1247 patients with duration of follow-up less than 1year were included in the analysis. Age and gender distribution were similar among the two groups. Group with more than 1 year follow up (M=8.4, SD-1.8) had significantly lower A1c compared to new patients with less than 1 year follow-up (M=9.1%, SD=2.2), t(2009) = 7.25, p < .0001.Regression analysis also indicated that A1c tends to be lower with higher C-peptide (R2=0.01,F (4,819)=2.7, p=0.02). Linear regression also showed no significant change of C-peptide levels with duration under care.

In patients on long term follow up and low HbA1c value when compared with newly enrolled patients, there was no decline in C-peptide levels in DTMS® based follow up care. Maintaining near normal glycemic targets in type 2 diabetes patients may help preserve the beta cell function even after decades of onset of diabetes.