SAT-515 Syndrome of Diabetes Remission in the setting of End Stage Renal Disease (ESRD)- A Case Series

Abstract Disclosure: C. Nguyen: None. M. Chiang: None. G.I. Uwaifo: None. Background; Diabetes Remission (DMR) is the metabolic state of restoration of normoglycemia with HBA1C < 5.7 without need of antidiabetic medications (ADM) in patients with known diabetes mellitus (DM). ESRD is associated with reduced ADM doses especially insulin and less commonly total resolution of ADM use with DMR. We present 3 patients with DMR in the setting of ESRD. Cases series; Case 1 is a 67 yr old man with type 2 diabetes (T2DM) of > 35 yr and strong family history. He has Hep C associated liver cirrhosis. He was initially managed with oral ADM then insulin only for the last 12yrs when he developed steadily declining renal function. He developed ESRD on dialysis in the preceding 7 yrs. At his prior contact with the endocrine consult service 4 yrs ago he had diabetic ketoacidosis (DKA) with HBA1C of 13. His DM is managed by his primary care provider (PCP) and at his next endocrine consult for hypocalcemia was noted to have been in DMR for prior 2 yrs with a current HBA1c of 4.9 on no ADM and BMI of 22.2kg/m2. CGMS profile confirmed normoglycemia. Case 2 is a 71 yr old man with T2DM of > 31 yr. He was initially managed with oral ADM and basal insulin eventually added. His 1st hospital admission with renal dysfunction was 3 yrs ago with an acute coronary syndrome and renal function rapidly declined from then to ESRD requiring dialysis with poorly controlled hypertension. Over the last 3 yrs he had all prior ADM discontinued and at his latest endocrine evaluation for evaluation of possible hypoglycemic episodes his HBA1c was 5.3 and BMI of 18 kg/m2. Case 3 is a 64 yr old man presumed T2DM of >24 yr initially started on oral ADM. He had multi dose insulin therapy added to his treatment ∼ 10 yrs ago on account of worsening glycemic control and by this time he had CKD stage 3b. Soon thereafter he progressed to ESRD on dialysis therapy. His T2DM was largely managed by his PCP and in the last 4 yrs had all ADM including insulin discontinued with nadir HBA1c of 4.7 and BMI of 26.5 kg/m2. He was recently re-evaluated by the endocrine service for possible tertiary hyperparathyroidism. Discussion; DMR in the setting of ESRD is a distinct entity but its exact prevalence, determinants and clinical consequences remain poorly understood and characterized. Our case series identified 3 caucasian men and common themes identified were the rapid onset of DMR following onset of ESRD (all <5 yrs from dialysis commencement) despite prior history of longstanding T2DM ( all >20 yrs). Also all our patients are normal to underweight with most having advanced micro and macrovacular disease. Conclusions; The entity of DMR in patients with DM and ESRD requires further study to help define the phenotype, predictors and clinical profile of patients that develop this and what implications it has for future cardiometabolic morbidity, mortality as well as hospital related admissions for typical DM related complications like DKA and hypoglycemia. Presentation: Saturday, July 12, 2025