Approximately 70% of obese African American (AA) patients with new-onset diabetic ketoacidosis (DKA) and severe hyperglycemia (SH) achieve near-normoglycemia remission (defined as HbA1c <7%, fasting blood glucose [BG]< 130 mg/dl, and off insulin for 1 month) with intensive insulin treatment. The shape of glucose response curve during OGTT has been shown predictive of future glycemic failure and beta(β)-cell function in adolescents with diabetes and adults. Biphasic (Bφ) curves showing better glycemic control and β-cell function compared to monophasic (Mφ) or incessant rise (IR) curves. We hypothesize that in AA patients with new-onset DKA and SH, Bφ shape at remission is associated with lower hyperglycemia relapse compared to Mφ or IR curves. Seventy AA patients underwent a 75g two-hour OGTT after near-normoglycemia remission and at end of study (median follow-up, 392 days). Insulin sensitivity (Si, oral minimal model) and β-cell function (AUCi: incremental area under the curve of insulin), and disposition index (Di= Si x AUCi) were compared among the different OGTT response curves. Hyperglycemia relapse-free survival (fasting BG > 130 mg/dl, 2 random BG > 180 mg/dl or HbA1c > 7%) was calculated with Kaplan-Meier curve. At remission, initial OGTT showed 56% of patients with Mφ, 16% with Bφ, and 29% with IR curve shape. Baseline characteristics did not differ. Even though, more patients in the Bφ group (88%) sustained remission than the Mφ (57%) and IR (53%), hyperglycemia relapse-free survival did not differ by curve shape (log rank, p=0.26). On initial OGTT, Si (p=0.09), AUCi (p=0.12) and Di (p=0.06) did not differ between curve shapes. At last OGTT, Si (p=0.43), AUCi (0.47) and Di (p=0.22) did not differ. In obese AA patients with new-onset DKA and SH, the shape of the glucose response curve during OGTT does not predict long-term glycemic control or β-cell function.
L. Cotten: None. D. Stefanovski: None. O. Oladejo: None. G.E. Umpierrez: None. P. Vellanki: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc.
National Institutes of Health (K08DK0830361, K23DK113241-01A1, UL1TR002378, 1P30DK111024-01)