Diabetic Ketoacidosis in Obese African-Americans

Abstract

Our preliminary data indicate that 15% of African-American patients presenting with diabetic ketoacidosis (DKA) are obese. To determine underlying mechanisms, we analyzed the clinical characteristics and indexes of insulin secretion and insulin sensitivity in 35 obese patients with DKA, 22 obese patients with hyperglycemia, 10 lean patients with DKA, and 10 obese nondiabetic subjects. Studies were performed 1 day after resolution of DKA and after 12 weeks of follow-up. At presentation, both obese DKA and obese hyperglycemic patients had no detectable insulin response to intravenous glucose, but they did respond to glucagon administration. The acute insulin response (AIR) to glucagon in obese DKA patients (0.9 +/- 0.1 ng/ml, P < 0.01), but significantly greater than in lean patients with DKA (0.1 +/- 0.1 ng/ml, P < 0.01). After 12 weeks of follow-up, the AIR to glucose improved in both groups of obese diabetic patients but remained significantly lower than in nondiabetic control subjects (both P < 0.01). In contrast, the AIR to glucagon was not significantly different from that in obese control subjects. Insulin sensitivity was decreased in both groups of obese diabetic patients at presentation and improved after follow-up to levels similar to those in obese nondiabetic control subjects. Reactivity with islet cell antibodies was not detected in any of the patients. During follow-up, 25 of 35 obese DKA and 16 of 22 hyperglycemic patients were able to discontinue insulin therapy, with continued good metabolic control. Our results indicate that in African-Americans, obese patients with DKA represent a subset of type II diabetes.(ABSTRACT TRUNCATED AT 250 WORDS)

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

“…This association was evidenced, with a predominance of insulin secretory defect in metabolic studies of atypical diabetes [1,2,9]. Predominant insulin secretory defect is known to be a feature of Type II diabetes in populations of African ancestry [14,15].…”

“…Latent autoimmune diabetes is not plausible since late appearance of islet-cell autoimmunity has not been reported. Obesity, which is an exceptional finding in classic Type I diabetes, is found in up to 56 % of the cohorts of patients with this atypical presentation [8] and mean BMI varies between 26 and 37 kg/m 2 [1,2,9,10].…”

“…In the subtype we are referring to, no evidence of autoimmune destruction of beta cells has been reported. There is, however, a blunted insulin response to glucose that partially recovers with normoglycaemic control [2]. Moreover, the insulin secretory response to glucagon is partially preserved [9].…”

Steroid-Induced Diabetic Ketoacidosis in a Patient with Type 2 Diabetes Mellitus

“…Although DKA in patients with T2DM tends to have less severe acidosis (18,19), our patient had severe acidosis. Our patient also had a high insulin requirement, which may not be unusual for DKA in T2DM, as patients may require larger amounts of insulin to correct hyperglycemia (20).…”

“…On a more positive note, other studies have shown that about 50 to 66% of patients with T2DM who were admitted to the hospital due to DKA and required insulin on discharge, were able to stop insulin at some point (4,20,22). This may reflect recovery of beta cell function after resolution of the acute hyperglycemic episode (glucotoxicity).…”