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Factors associated with insulin discontinuation in subjects with ketosis‐prone diabetes but preserved β‐cell function
Author(s) -
Maldonado M. R.,
Otiniano M. E.,
Cheema F.,
Rodriguez L.,
Balasubramanyam A.
Publication year - 2005
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 - 10.1111/j.1464-5491.2005.01724.x
Subject(s) - medicine , discontinuation , insulin , ketosis , diabetes mellitus , type 2 diabetes , hazard ratio , endocrinology , ketoacidosis , type 1 diabetes , confidence interval
Aim To evaluate factors predictive of insulin discontinuation in subjects with ketosis‐prone Type 2 diabetes. Methods One hundred and six subjects with ketosis‐prone Type 2 diabetes were recruited during the index episode of diabetic ketoacidosis (DKA). All subjects were followed in a special clinic for at least 6 months. If the subject's glycaemic control reached specified glycaemic goals, exogenous insulin was gradually decreased until discontinuation. Baseline and follow‐up characteristics were compared between the off‐insulin and the on‐insulin groups. Results At the end of the follow‐up period (915 ± 375 days) insulin was discontinued in 47% subjects. Subjects in the off‐insulin group were significantly older at the time of diagnosis of diabetes. In the off‐insulin group the majority of subjects were newly diagnosed with diabetes. After 6 months of follow‐up, subjects in the off‐insulin group had significantly lower mean HbA 1c , higher mean C‐peptide‐to‐glucose ratio and had more clinic visits per year. In the proportional hazard analysis, new‐onset diabetes [hazard ratio (HR) 1.54; 95% confidence interval (CI) 1.02–2.45], and a higher C‐peptide‐to‐glucose ratio at 6 months of follow‐up (HR 1.77; 95% CI 1.22–2.63) were significant predictors of insulin discontinuation. Conclusions In subjects with ketosis‐prone Type 2 diabetes, the best predictors of insulin discontinuation are having new‐onset diabetes, and higher β‐cell functional reserve (as measured by the C‐peptide‐to‐glucose ratio).