title: Factors associated with early relapse to insulin dependence in unprovoked A-β+ ketosis-prone diabetes.
abstract: OBJECTIVE
  Unprovoked "A-β+" Ketosis-Prone Diabetes (KPD), a unique diabetic syndrome of adult-onset, obesity and proneness to ketoacidosis, is associated with rapid recovery of β 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-β+ KPD patients with >2 measurements of β 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-%β (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 HOMA2-%β and HbA1c at 1 year provided a good fit (P<0.05).
  
  
  CONCLUSIONS
  Relapse to insulin dependence in unprovoked A-β+ KPD patients is associated with younger age and, after 1 year, lack of robust increase in β 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.
authors.affiliation: Translational Metabolism Unit, Diabetes Research Center, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX; Endocrine Service, Ben Taub General Hospital, Houston, TX.
authors.forename: Ruchi
authors.initials: R
authors.lastname: Gaba
authors.affiliation: University of Texas School of Public Health, Houston, TX.
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Gambhire
authors.affiliation: Translational Metabolism Unit, Diabetes Research Center, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX.
authors.forename: Natalie
authors.initials: N
authors.lastname: Uy
authors.affiliation: Translational Metabolism Unit, Diabetes Research Center, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX; Endocrine Service, Ben Taub General Hospital, Houston, TX.
authors.forename: Erica V
authors.initials: EV
authors.lastname: Gonzalez
authors.affiliation: Translational Metabolism Unit, Diabetes Research Center, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX.
authors.forename: Dinakar
authors.initials: D
authors.lastname: Iyer
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA.
authors.forename: Christiane S
authors.initials: CS
authors.lastname: Hampe
authors.affiliation: Translational Metabolism Unit, Diabetes Research Center, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX; Endocrine Service, Ben Taub General Hospital, Houston, TX.
authors.forename: Nalini
authors.initials: N
authors.lastname: Ram
authors.affiliation: Translational Metabolism Unit, Diabetes Research Center, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX; Endocrine Service, Ben Taub General Hospital, Houston, TX. Electronic address: ashokb@bcm.edu.
authors.forename: Ashok
authors.initials: A
authors.lastname: Balasubramanyam
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001786:Blood Glucose / Q000032:analysis; D016208:Databases, Factual; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D016883:Diabetic Ketoacidosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006680:HLA Antigens / Q000097:blood; D006801:Humans; D007328:Insulin / Q000008:administration & dosage*; D050417:Insulin-Secreting Cells / Q000502:physiology*; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D006680:HLA Antigens; D007328:Insulin
keywords: Beta-cell; HLA; Insulin-dependence; Ketoacidosis; Multivariate