Phenotype and predictors of insulin independence in adults presenting with diabetic ketoacidosis: a prospective cohort study
Authors' conclusion
The predominant phenotype of adults presenting with a first episode of DKA in Cape Town, South Africa, was that of ketosis-prone type 2 diabetes. These individuals presented with obesity, acanthosis nigricans, negative antibodies and normal C-peptide and could potentially be weaned off insulin at follow-up. Classic type 1 diabetes (lower weight, antibody positivity, low or unrecordable C-peptide levels and long-term insulin dependence) was less common. The simple clinical sign of acanthosis nigricans is a strong predictor of insulin independence at 12 months and 5 years after initial presentation.
Study context
- Population
- Adults ≥18 years presenting for the first time with diabetic ketoacidosis (DKA), newly diagnosed with diabetes, Groote Schuur Academic Health Complex, Cape Town, South Africafollowed 5 years
- Participants
- 88 adults
- Outcome
- Insulin independence (predictors)
- Follow-up
- 12 and 60 months after presentation
Methodological detailsdescriptive, four public-sector hospitals, Insulin systematically weaned and stopped in those achieving normoglycaemia after DKA
- Descriptive
- Four public-sector hospitals
- Insulin systematically weaned and stopped in those achieving normoglycaemia after DKA
Main finding
As reported in the abstract
- Insulin independent at 12 months
- 46%
- Insulin independent at 5 years
- 26%
- Acanthosis nigricans and insulin independence: OR 27.1 (95% CI 7.2, 102.2)
- p<0.001
- Positive antibody status and insulin independence at 12 months: OR 0.10 (95% CI 0.03, 0.36)
- p<0.001
- Multivariable: acanthosis predictive of insulin independence at 5 years, OR 11.5 (95% CI 2.5, 53.2)
- p=0.004
Observational data: associations, not effects.
Further findings
Baseline characteristics · diagnosis
- Age, mean ± SD
- 35±10 years
- BMI, median (IQR)
- 28.5 (23.3-33.4) kg/m²
Antibody-negative (anti-GAD, anti-IA-2) with C-peptide >0.3 nmol/l
- Participants
- 41 (47%)
- Insulin independent at 12 months
- 68%
- Insulin independent at 5 years
- 37%
Original publication
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