Adult-onset idiopathic Type I or ketosis-prone Type II diabetes: evidence to revisit diabetes classification

Sobngwi, Eugène; Gautier, J.F.

doi:10.1007/s00125-001-0739-8

Cited by 59 publications

(38 citation statements)

References 9 publications

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“…However, most investigators who study this form of diabetes still continue to attribute different names, such as atypical diabetes, Flatbush diabetes, phasic insulin-dependent diabetes, and more recently ketosis-prone diabetes (5,8 -10,13,20), thus reflecting the inadequacy of the current classification. Most clinical studies that have focused on ketosis-prone type 2 diabetes suggest disease-specific metabolic defects (5,6), and the classification of these syndromes in the type 1 diabetes group is today a subject of increasing controversy (7,20). However, so far, prospective follow-up of insulin secretion and action is lacking to propose a new classification based on pathogenesis.…”

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confidence: 99%

Ketosis-Prone Type 2 Diabetes in Patients of Sub-Saharan African Origin

et al. 2004

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Nonautoimmune ketosis-prone diabetic syndromes are increasingly frequent in nonwhite populations. We have characterized a cohort of patients of sub-Saharan African origin who had ketosis-prone type 2 diabetes (n ‫؍‬ 111), type 1 diabetes (n ‫؍‬ 21), and type 2 diabetes (n ‫؍‬ 88) and were admitted to a hospital for management of uncontrolled diabetes. We compared epidemiological, clinical, and metabolic features at diabetes onset and measured insulin secretion (glucagon-stimulated C-peptide) and insulin action (short intravenous insulin tolerance test) during a 10-year follow-up. Ketosis-prone type 2 diabetes shows a strong male predominance, stronger family history, higher age and BMI, and more severe metabolic decompensation than type 1 diabetes. In ketosis-prone type 2 diabetes, discontinuation of insulin therapy with development of remission of insulin dependence is achieved in 76% of patients (noninsulin dependent), whereas only 24% of patients remain insulin dependent. During evolution, ketosisprone type 2 diabetes exhibit specific ␤-cell dysfunction features that distinguish it from type 1 and type 2 diabetes. The clinical course of non-insulin-dependent ketosis-prone type 2 diabetes is characterized by ketotic relapses followed or not by a new remission. Progressive hyperglycemia precedes and is a strong risk factor for ketotic relapses (hazard ratio 38). The probability for non-insulin-dependent ketosis-prone type 2 diabetes to relapse is 90% within 10 years, of whom ϳ50% will become definitively insulin dependent. Insulin sensitivity is decreased in equal proportion in both ketosis-prone type 2 diabetes and type 2 diabetes, but improves significantly in non-insulin-dependent ketosis-prone type 2 diabetes, only after correction of hyperglycemia. In conclusion, ketosis-prone type 2 diabetes can be distinguished from type 1 diabetes and classical type 2 diabetes by specific features of clinical pathophysiology and also by the natural history of ␤-cell dysfunction and insulin resistance reflecting a propensity to glucose toxicity. Diabetes 53: [645][646][647][648][649][650][651][652][653] 2004

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confidence: 99%

Ketosis-Prone Type 2 Diabetes in Patients of Sub-Saharan African Origin

et al. 2004

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“…Outras possibilidades seriam algum distúrbio na secreção de glucagon, o principal hormônio cetogênico em humanos, ou um componente genético que tornasse um subgrupo de pacientes com DM 2 particularmente propensos à CAD (3). Entretanto, apesar de os pacientes com diabetes flatbush apresentarem uma elevada prevalência de história familiar de DM 2, seus parentes não são necessariamente predispostos a essa complicação aguda (1,4).…”

Section: Discussionunclassified

Relato de caso: diabetes Flatbush - da cetoacidose ao tratamento não-farmacológico

Rodacki

Zajdenverg

Lima

et al. 2007

Arq Bras Endocrinol Metab

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RESUMOUm subgrupo de pacientes, em sua maioria negros ou hispânicos e obesos, tem a cetoacidose diabética (CAD) como forma de apresentação de diabetes mellitus (DM), mas, devido à sua evolução clínica, posteriormente é classificado como DM tipo 2. Estes indivíduos têm pesquisa de auto-anticorpos anti-GAD, anti-IA2 e anti-insulina negativa, mas freqüen-temente em associação com HLA classe II de risco para DM tipo 1 (DRB1*03 e/ou DRB1*04). Este subtipo peculiar de DM é denominado diabetes flatbush. Neste artigo, relatamos o caso de uma paciente de origem caucasiana com tais características, na qual foi possível retirada da insulinoterapia. Os possíveis fatores associados a esta evolução favorável serão discutidos. A subgroup of patients presents diabetic ketoacidosis at the onset of diabetes mellitus (DM) but later is classified as type 2 DM based on the clinical follow-up. These individuals, most commonly obese of African or Hispanic origin, have negative auto-antibodies associated with type 1 DM, but frequently HLA class II DRB1*03 and/or DRB1*04 are detected. This peculiar subtype of DM is commonly referred to as diabetes flatbush. Here we report the case of a Caucasian patient that exhibited the described evolution and in whom it was possible to withdraw insulin therapy. The possible factors associated with this favorable development are also discussed. A CETOACIDOSE DIABÉTICA (CAD) é uma complicação metabólica aguda do diabetes mellitus (DM) caracterizada por hiperglicemia, cetose e acidose. Apesar de ser tradicionalmente considerada como uma característica específica do DM tipo 1, tem se tornado cada vez mais claro que esta complicação pode ocorrer também em pacientes com DM tipo 2 (1). Há relatos em diversas populações, especialmente de etnia hispânica ou africana, de indivíduos que apresentam CAD como forma de apresentação inicial do DM, porém subseqüentemente desenvolvem curso clínico compatível com DM tipo 2, muitas vezes sendo possível a interrupção da insulinoterapia. Neste subgrupo de pacientes, não são identificados auto-anticorpos associados ao DM 1 e freqüentemente há preservação ou recuperação da função pancreática endócrina. Entretanto, é apresentação de caso

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“…5 Some authors, however, suggest that 'ketosis prone type 2 diabetes' is a more useful term to describe this cohort of patients. 6,7 This form of diabetes has similarities with type 1 and type 2. It is characterized by episodic ketosis, without immunological markers of type 1 diabetes, insulin dependence at the time of diagnosis (as seen in type 1 diabetes), but subsequent lack of insulin requirement, frequently for years (as seen in type 2 diabetes).…”

Section: Discussionmentioning

confidence: 99%