2463-P: Trajectory of Dynamic and Static Phase Insulin Secretion in Ketosis-Prone Diabetes

Introduction and Objective: Ketosis-prone diabetes (KPD) presents with diabetic ketoacidosis (DKA) and subsequent variable β-cell recovery and insulin independence after intensive insulin therapy. The durability of this recovery is unclear. We assessed whether aggressive insulin therapy improves dynamic and static insulin secretion and if these changes persist one year after insulin independence. Methods: Twenty-three KPD subjects underwent a 7-sample 120-min OGTT one week after insulin independence (remission) and again within one year. OGTT-derived estimates of Φ_dynamic (first-phase) and Φ_static (second-phase insulin secretion) were calculated. Model-adjusted marginal means were obtained using mixed-effects generalized linear models with time as a fixed factor and subject-level random effects. Results: At one year, Φ_dynamic (P=0.03) and Φ_static (P<0.05) declined significantly, with greater reduction in Φ_dynamic (47%) vs Φ_static (22%) from remission from insulin to follow-up (Figure). Conclusion: Aggressive insulin therapy initially improves both phases of insulin secretion but does not confer long-term β-cell protection. Decline in dynamic secretion, previously linked to higher type 2 diabetes risk, may signal early relapse in KPD, suggesting accelerated deterioration within a year. Disclosure D. Stefanovski: None. O. Oladejo: None. A. Verma: None. P. Vellanki: Consultant; Ended; Sanofi, RTI International. Funding National Institutes of Health (1K23DK113241-01A1)