Factors associated with insulin discontinuation in subjects with ketosis-prone diabetes but preserved β-cell function
Factors associated with insulin discontinuation in subjects with ketosis-prone diabetes but preserved β-cell function
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DOI：
10.1111/j.1464-5491.2005.01724.x
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发表时间：
2005-12-01
影响因子：
3.5
通讯作者：
Balasubramanyam, A
中科院分区：
文献类型：
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作者：
Maldonado, MR;Otiniano, ME;Balasubramanyam, A
目的探讨酮症倾向2型糖尿病（Ketosis-prone Type 2 DM，DM）患者在发生糖尿病酮症酸中毒（DKA）时停用胰岛素的预测因素。所有受试者在特殊诊所随访至少6个月。如果受试者的血糖控制达到规定的血糖目标，则逐渐减少外源性胰岛素直至停药。基线和后续的特点进行了比较的非胰岛素和on-insulin groups.Results在随访期结束时（915 +/- 375天），胰岛素被中止47%的受试者。胰岛素治疗组的受试者在诊断糖尿病时年龄明显较大。在胰岛素停药组中，大多数受试者新诊断为糖尿病。随访6个月后，停用胰岛素组的受试者平均HbA（1c）显著降低，平均C肽与葡萄糖比值较高，每年门诊就诊次数较多。在比例风险分析中，新发糖尿病[风险比（HR）1.54; 95%置信区间（CI）1.02-2.45]和6个月随访时较高的C肽-葡萄糖比（人力资源1.77; 95%CI 1.22-2.63）是胰岛素停药的显著预测因子。胰岛素停药的最佳预测因子是新发糖尿病和较高的β细胞功能储备（通过C肽与葡萄糖的比率测量）。
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 beta-cell functional reserve (as measured by the C-peptide-to-glucose ratio).