Predictors of glycaemic control in indigent patients presenting with diabetic ketoacidosis.
OBJECTIVE
To derive predictors of good glycaemic control in patients presenting with diabetic ketoacidosis (DKA) followed prospectively in a specialized clinic.


METHODS
One hundred and sixty-one adult patients were admitted during a 31-month period and followed for at least 12 months. After 1 year, the patients were classified into three groups: good control (GC) (HbA1c < or = 7%), intermediate control (IC) (HbA1c 7-9%) and poor control (PC) (HbA1c > 9%). Characteristics of patients in the three groups were compared both at baseline and during follow-up.


RESULTS
At 12 months, 36% of the patients were classified as GC, 27% as IC and 37% as PC. GC patients had higher fasting serum C-peptide levels 0.7 +/- 0.54 compared to 0.38 +/- 0.29 and 0.16 +/- 0.21 nmol/l, respectively, for the IC and PC patients (p < 0.0001). A higher proportion GC patient had a C-peptide level greater than 0.33 nmol/l than that for IC and PC patients (86, 61 and 19%, respectively; p < 0.0001). Exogenous insulin was safely discontinued in 50, 30 and 3% of patients, respectively, in the GC, IC and PC groups (p < 0.0001). Compliance with life-style interventions was higher in the GC than that in IC and PC patients (87, 41 and 5%, respectively; p < 0.0001). In the logistic regression analysis, predictors of good glycaemic control were having baseline fasting serum C-peptide value > or =0.33 mmol/l, OR: 3.01 (95% CI 1.07-8.55, p = 0.03) and compliance with life-style interventions OR 12.66 (95% CI 3.73-51.57, p = 0.0001).


CONCLUSIONS
Among adult patients with DKA, significant predictors of good glycaemic control are preserved beta-cell function and compliance with life-style modifications.
Maldonado
M
M
Department of Medicine/Endocrinology, Baylor College of Medicine, One Baylor Plaza, Rm. N520, Houston, TX 77030, USA. mariom@bcm.tmc.edu
D'Amico
S
S
Otiniano
M
M
Balasubramanyam
A
A
Rodriguez
L
L
Cuevas
E
E
D000328:Adult; D015415:Biomarkers / Q000097:blood; D002096:C-Peptide / Q000032:analysis*; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000188:drug therapy / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010349:Patient Compliance; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome
D015415:Biomarkers; D002096:C-Peptide; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents