KETOACIDOSIS AT DIAGNOSIS IS PREDICTIVE OF LOWER RESIDUAL BETA-CELL FUNCTION AND POOR METABOLIC CONTROL IN TYPE-1 DIABETES

To determine the factors at diagnosis predictive of changes in residua l beta-cell function and metabolic control in Type 1 diabetes, 125 pat ients older than 7 years of age consecutively diagnosed between March 1986 and June 1991 were followed prospectively for two years. The effe ct of age, gender and the presence of ketoacidosis (DKA) and islet-cel l antibodies (ICA) on beta-cell function, metabolic control and insuli n requirements were studied by multivariate analysis of variance (repe ated measurements overtime) in 90 patients who completed followup. DKA had an independent negative effect on residual beta-cell function ove r time (p = 0.001). ICA-positive patients had lower residual beta-cell function at the end of follow-up (p < 0.05), but overall differences were not significant DKA and younger age had an independent negative i nfluence on metabolic control (p < 0.05) and insulin requirements (p < 0.001) overtime. It is concluded that residual beta-cell function in Type 1 diabetic patients two years after diagnosis was independently i nfluenced by DKA and ICA at diagnosis. Moreover, DKA and age influence d metabolic control and could thus be used to predict those patients w ith rapidly deteriorating metabolic control who might benefit from a m ore intensive therapeutic approach.