In obese Blacks presenting with diabetic ketoacidosis (DKA) at new-onset of diabetes, intensive insulin treatment improves β-cell function so that ˜70% achieve near-normoglycemia remission (HbA1c < 7%, fasting blood glucose [BG]<130 mg/dl while off insulin for ≥1 week) and maintain glycemic control without medications. The 2021 American Diabetes Association (ADA) consensus defined diabetes remission as HbA1c <6.5% or BG 126 mg/dl while off medications for >3 months. It is unknown whether glycemic measures and insulin secretion differ between patients who achieve the new ADA definition of remission (intensive remission [IR]) compared to near-normoglycemia remission (non-intensive remission [NIR]) .We performed 75-g, 240-minute (min) oral glucose tolerance tests (OGTT) in 13 obese (BMI>30 kg/m2) Blacks who presented with DKA (BG>250 mg/dl, HCO3<18 mEq/L, pH<7.3) and achieved remission from insulin. Glucose and C-peptide levels were measured at -15, 0, 10, 20, 30, 60, 90, 120, 180 and 240 min during OGTT. Insulin secretory rates (ISR) , first phase (Φdynamic) , second phase (Φstatic) and total (Φtotal) insulin secretion were calculated using a previously published model. Data was compared between IR, (HbA1c<6.5%, n=7) vs. NIR, (HbA1c≥6.5%, n=6)) There were no differences in age, BMI and mean BG levels during OGTT between groups. Model estimates of Φdynamic were significant (P=0.046) and 5-fold higher in IR (Marginal Mean: 514.00, 95% CI: 134.53-893.47 ) vs. NIR (Marginal Mean: 100, 95% CI: 100.45, 95% CI: -41.97-242.87 ) . Estimates of Φstatic were significant (P=0.022) and 2-fold higher in the IR (Marginal Mean: 31.84, 95% CI: 19.88-43.80 [min-1]) vs. NIR (Marginal Mean: 14.59, 95% CI: 6.79-22.39 [min-1]) with no significant (P=0.058) group differences between Φtotal.In comparison to NIR, obese Blacks with IR exhibit marked preservation of β-cell function suggesting that HbA1c <6.5% should be targeted for insulin remission after presentation with DKA.
D.Stefanovski: None. O.Oladejo: None. G.E.Umpierrez: Research Support; AstraZeneca, Dexcom, Inc., Novo Nordisk. P.Vellanki: n/a.
NIH/NIDDK K23 DK11324-01A1