Heterogeneity in the clinical course of T2D in youth presenting with and without diabetic ketoacidosis (DKA) at diagnosis is not well described. In this study, we aimed to characterize if presentation with DKA affects rates of insulin discontinuation compared to T2D without ketosis (non-DKA). This single-center retrospective cohort study included patients (BMI 33.7 IQR 29.1,38.6) with mean age 15 years (IQR 13,16), admitted for new-onset DKA (n= 77) or non-DKA (n=361) from 2019-2021 with 1-year follow-up. All patients were initiated on insulin and titrated per their care team. Type 1 diabetes was excluded by presence of autoimmune antibodies. Primary outcomes were discontinuation of insulin therapy and maintenance of discontinuation 1 year after diagnosis. There were no differences in the proportion of (p=0.63) or time to insulin discontinuation (p=0.20) between DKA and non-DKA. Trajectory analyses identified 3 insulin discontinuation groups: early (within 2 months), late (within 6 months), and never (Figure 1). Multinomial regression shows that DKA at presentation is not associated with early (p=0.60) or late insulin discontinuation (p=0.59) compared to never discontinuation. We identified heterogeneity in duration of insulin treatment in youth with new-onset T2D with and without DKA at presentation. Prospective studies are needed to characterize differences in β-cell function that may predict insulin dependence.
S. Hao: None. A. Westbrook: None. C.B. Sinha: None. D.S. Hsia: None. P. Vellanki: Consultant; Eli Lilly and Company.
