Factors associated with discontinuing insulin therapy after diabetic ketoacidosis in adult diabetic patients

Aims: To assess the factors associated with successful discontinuation of insulin therapy after diabetic ketoacidosis (DKA) in adult patients. Methods: Patients (≥ 18 years) attending the Endocrine and Metabolism Clinic at a major hospital in southern Taiwan were recruited. After recovery from the acute stage, those with no contraindications to oral antidiabetic agents, with adequate β cell reserve, and with no antiglutamic acid decarboxylase (GAD) antibody were treated with oral agents. Results: Sixty-six patients (38 males, 28 females, aged 18-76 years) were included, and 21 qualified for treatment with oral agents. These 21 patients were older at diagnosis of diabetes (45.5 ± 14.0 vs. 40.0 ± 13.8 years, P = 0.047), had shorter diabetes duration (median 0 vs. 5.5 months, P = 0.040), higher BMI (median 23.4 vs. 19.5 kg/m², P < 0.001), higher serum osmolality during DKA (352.1 ± 40.7 vs. 318.0 ± 16.4 mmol/kg, P = 0.005), and lower insulin dose following recovery (median 0.49 vs. 0.83 unit/kg/d, P < 0.001) than those patients that had to continue insulin therapy. Thirteen patients (8 males, 5 females; 62%) successfully discontinued insulin for at least one year without recurrence of DKA. Multiple logistic regression analyses showed that BMI ≥ 25 kg/m² (adjusted relative risk (ARR) 8.85, 95% CI 1.05, 8.39), diabetes onset age ≥ 40 years (ARR 8.08, 95% CI 1.16, 6.95), and undiagnosed diabetes before DKA (ARR 8.90, 95% CI 1.19, 7.51) were significant factors associated with successful discontinuation of insulin therapy. Conclusion: We identified three independent clinical factors associated with successful discontinuation of insulin therapy after DKA.