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Factors associated with discontinuing insulin therapy after diabetic ketoacidosis in adult diabetic patients
Author(s) -
Hsin Yu E.,
Guo H.R.,
Wu TaJen
Publication year - 2001
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1046/j.0742-3071.2001.00596.x
Subject(s) - medicine , diabetic ketoacidosis , diabetes mellitus , discontinuation , insulin , ketoacidosis , gastroenterology , endocrinology , type 1 diabetes
Aims To assess the factors associated with successful discontinuation of insulin therapy after diabetic ketoacidosis (DKA) in adult patients. Methods Patients (≥ 18 years) attending the Endocrine and Metabolism Clinic at a major hospital in southern Taiwan were recruited. After recovery from the acute stage, those with no contraindications to oral antidiabetic agents, with adequate β cell reserve, and with no antiglutamic acid decarboxylase (GAD) antibody were treated with oral agents. Results Sixty‐six patients (38 males, 28 females, aged 18–76 years) were included, and 21 qualified for treatment with oral agents. These 21 patients were older at diagnosis of diabetes (45.5 ± 14.0 vs. 40.0 ± 13.8 years, P = 0.047), had shorter diabetes duration (median 0 vs. 5.5 months, P = 0.040), higher BMI (median 23.4 vs. 19.5 kg/m 2 , P < 0.001), higher serum osmolality during DKA (352.1 ± 40.7 vs. 318.0 ± 16.4 mmol/kg, P = 0.005), and lower insulin dose following recovery (median 0.49 vs. 0.83 unit/kg/d, P < 0.001) than those patients that had to continue insulin therapy. Thirteen patients (8 males, 5 females; 62%) successfully discontinued insulin for at least one year without recurrence of DKA. Multiple logistic regression analyses showed that ΒΜΙ ≥ 25 kg/m 2 (adjusted relative risk (ARR) 8.85, 95% CI 1.05, 8.39), diabetes onset age ≥ 40 years (ARR 8.08, 95% CI 1.16, 6.95), and undiagnosed diabetes before DKA (ARR 8.90, 95% CI 1.19, 7.51) were significant factors associated with successful discontinuation of insulin therapy. Conclusion We identified three independent clinical factors associated with successful discontinuation of insulin therapy after DKA. Diabet. Med. 18, 895–899 (2001)