Predictors of glycaemic control in indigent patients presenting with diabetic ketoacidosis

  1. M. Maldonado1,2,*,
  2. S. D'Amico1,
  3. M. Otiniano1,
  4. A. Balasubramanyam1,2,
  5. L. Rodriguez2,
  6. E. Cuevas1

Article first published online: 18 NOV 2004

DOI: 10.1111/j.1463-1326.2004.00394.x

Issue

Diabetes, Obesity and Metabolism

Diabetes, Obesity and Metabolism

Volume 7, Issue 3, pages 282–289, May 2005

Additional Information

How to Cite

Maldonado, M., D'Amico, S., Otiniano, M., Balasubramanyam, A., Rodriguez, L. and Cuevas, E. (2005), Predictors of glycaemic control in indigent patients presenting with diabetic ketoacidosis. Diabetes, Obesity and Metabolism, 7: 282–289. doi: 10.1111/j.1463-1326.2004.00394.x

Author Information

  1. 1

    Department of Medicine/Endocrinology, Baylor College of Medicine, Houston, TX, USA

  2. 2

    Department of Medicine/Endocrinology, The Ben Taub General Hospital, Houston, TX, USA

* *Mario Maldonado, MD, One Baylor Plaza, Room N520, Houston, TX 77030, USA. E-mail: mariom@bcm.tmc.edu

Publication History

  1. Issue published online: 4 APR 2005
  2. Article first published online: 18 NOV 2004
  3. Received 25 September 2003; returned for revision 22 April 2004; revised version accepted 22 April 2004

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Keywords:

  • HbA1c;
  • indigent;
  • ketosis-prone diabetes;
  • multiethnic

Aim:  To derive predictors of good glycaemic control in patients presenting with diabetic ketoacidosis (DKA) followed prospectively in a specialized clinic.

Methods:  One hundred and sixty-one adult patients were admitted during a 31-month period and followed for at least 12 months. After 1 year, the patients were classified into three groups: good control (GC) (HbA1c ≤ 7%), intermediate control (IC) (HbA1c 7–9%) and poor control (PC) (HbA1c > 9%). Characteristics of patients in the three groups were compared both at baseline and during follow-up.

Results:  At 12 months, 36% of the patients were classified as GC, 27% as IC and 37% as PC. GC patients had higher fasting serum C-peptide levels 0.7 ± 0.54 compared to 0.38 ± 0.29 and 0.16 ± 0.21 nmol/l, respectively, for the IC and PC patients (p < 0.0001). A higher proportion GC patient had a C-peptide level greater than 0.33 nmol/l than that for IC and PC patients (86, 61 and 19%, respectively; p < 0.0001). Exogenous insulin was safely discontinued in 50, 30 and 3% of patients, respectively, in the GC, IC and PC groups (p < 0.0001). Compliance with life-style interventions was higher in the GC than that in IC and PC patients (87, 41 and 5%, respectively; p < 0.0001). In the logistic regression analysis, predictors of good glycaemic control were having baseline fasting serum C-peptide value ≥0.33 mmol/l, OR: 3.01 (95% CI 1.07–8.55, p = 0.03) and compliance with life-style interventions OR 12.66 (95% CI 3.73–51.57, p = 0.0001).

Conclusion:  Among adult patients with DKA, significant predictors of good glycaemic control are preserved β-cell function and compliance with life-style modifications.

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