Factors associated with early relapse to insulin dependence in unprovoked A-β plus ketosis-prone diabetes

Objective: Unprovoked "A-beta+" Ketosis-Prone Diabetes (KPD), a unique diabetic syndrome of adult-onset, obesity and proneness to ketoacidosis, is associated with rapid recovery of beta cell function and insulin-independence. Whereas most patients experience prolonged remission, a subset relapses early to insulin dependence. We sought to define factors associated with early relapse. Methods: We utilized a prospective, longitudinal database to analyze 50 unprovoked A-beta+ KPD patients with >2 measurements of beta cell function and glycemia following baseline assessment. Results: 19 patients (38%) relapsed to insulin dependence <1 year after the index DKA episode, while 31(62%) remained insulin-independent for >1 year (median 4.2 years). Younger age at baseline (OR = 0.947, P = 0.033), and lower HOMA2-%beta (OR = 0.982, P = 0.001), lower HOMA2-IR (OR = 0.582, P = 0.046) and higher HbA1c at 1 year (OR = 1.71, P = 0.002) were associated with early relapse. A multivariate model with these variables and the interaction of HOMA-4%beta and HbA1c at 1 year provided a good fit (P<0.05). Conclusions: Relapse to insulin dependence in unprovoked A-beta+ KPD patients is associated with younger age and, after I year, lack of robust increase in beta cell functional reserve, and suboptimal glycemic control. Measurements of these parameters 1 year after the index DKA episode can be used to assess the need for insulin therapy. (C) 2015 Elsevier Inc. All rights reserved.