Ketosis‐prone atypical diabetes in Cameroonian people with hyperglycaemic crisis: frequency, clinical and metabolic phenotypes

Lontchi-Yimagou, Eric; Nguewa, J.-L.; Assah, Félix; Noubiap, Jean Jacques; Boudou, Philippe; Djahmeni, E.; Balti, Eric Vounsia; Atogho-Tiedeu, Barbara; Gautier, J.-F.; Mbanya, Jean Claude; Sobngwi, Eugène

doi:10.1111/dme.13264

“…Similar to previous studies, most T2DM patients with ketosis in this study were male and middle‐aged, with significantly impaired insulin secretion. Furthermore, the OGTT analyses and lipid profiles reported here in T2DM patients with or without ketosis are consistent with previous studies . Our data are also consistent with prior studies reporting that total osteocalcin is negatively correlated with plasma glucose levels and positively correlated with β‐cell function .…”

Section: Discussionsupporting

confidence: 93%

Circulating osteocalcin: A potential predictor of ketosis in type 2 diabetes

Zhu

¹

,

Lin

²

,

Chen

³

et al. 2020

Diabetes Metabolism Res

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Aims: Osteocalcin contributes to the regulation of endocrine system. However, the association between osteocalcin and ketosis has not been evaluated. We thus aimed to explore the relationship between total osteocalcin and risk of ketosis in type 2 diabetes (T2DM). Materials and methods:We identified 6157 diabetes patients from Shanghai Tenth People's Hospital between 1 January 2011 and 1 March 2017. Six hundred eight subjects were enrolled in the retrospective cross-sectional study: 304 T2DM patients with ketosis whose age, gender, and body mass index were matched with 304 T2DM patients without ketosis. A further retrospective nested case-control study was conducted in 252 T2DM patients without ketosis for a mean duration of 21.58 ± 12.43 months to investigate the occurrence of ketosis. Results: Osteocalcin levels were negatively correlated with blood ketones (adjusted r = −0.263) and urine ketones (adjusted r = −0.183). The inverse dose-dependent relationship of osteocalcin and risk of ketosis was present across osteocalcin level quintiles (top quintile as the reference, adjusted odds ratio [95% CI] = 2.56 [0.80-8.17], 3.71 [0.90-15.29], 10.77 [2.63-44.15], 23.81 [4.32-131.17] per osteocalcin quintile, respectively). Ketosis occurred in 17 of the 252 T2DM patients during follow-up. The Cox regression analysis indicated that osteocalcin was an independent protective factor against development of ketosis (adjusted hazard ratio [95% CI]: 0.668 [0.460-0.971]). Conclusions: Total osteocalcin can be used as a predictor of ketosis in T2DM. K E Y W O R D S ketosis, total osteocalcin, type 2 diabetes Bing Zhu and Ziwei Lin contributed equally as co-first authors.

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“…All had acanthosis nigricans -a physical marker suggestive of insulin resistance [22] . Interestingly, seven of 16 type 2 subjects presented in DKA, suggesting a diagnosis of ketosisprone type 2 diabetes, which is well-reported in populations in Africa and of African descent [23,24] . The youngest child was 10 mo of age at diagnosis.…”

Section: Discussionsupporting

confidence: 55%

Clinical profile of diabetes at diagnosis among children and adolescents at an endocrine clinic in Ghana

Ameyaw

¹

,

Sb

²

,

S

³

et al. 2018

ESPE

0

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AIM To determine the clinical features of diabetes in children and adolescents in Ghana. METHODS Retrospective review of clinical features of all children and adolescents with new-onset diabetes seen at the paediatric endocrinology clinic of Komfo Anokye Teaching Hospital in Kumasi, from February 2012 to Auguest 2016. RESULTS One hundred and six subjects presented with diabetes. Ninety (84.9%) were diagnosed by clinical features and family history as type 1, and 16 (15.1%) type 2. For type 1 subjects, age range at diagnosis was 0.9-19.9 year (y), peak age of onset 12-13 year, and 3.3% were < 5 year, 21.1% 5-< 10 year, 45.6% 10-< 15 year and 30.0% 15-< 20 year. Seventy-one point one percent were female. Common clinical features were polyuria (100%), polydipsia (98.9%), and weight loss (82.2%). Mean BMI SD was-0.54, range-3.84 to 2.47. 60.0% presented in diabetic ketoacidosis (DKA). Nine had infections at onset (skin, abscess, leg ulcer). Mean

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“…All had acanthosis nigricans - a physical marker suggestive of insulin resistance[ 22 ]. Interestingly, seven of 16 type 2 subjects presented in DKA, suggesting a diagnosis of ketosis-prone type 2 diabetes, which is well-reported in populations in Africa and of African descent[ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 78%

Clinical profile of diabetes at diagnosis among children and adolescents at an endocrine clinic in Ghana

Ameyaw

¹

,

Asafo-Agyei

²

,

S

³

et al. 2017

WJD

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AIMTo determine the clinical features of diabetes in children and adolescents in Ghana.METHODSRetrospective review of clinical features of all children and adolescents with new-onset diabetes seen at the paediatric endocrinology clinic of Komfo Anokye Teaching Hospital in Kumasi, from February 2012 to Auguest 2016.RESULTSOne hundred and six subjects presented with diabetes. Ninety (84.9%) were diagnosed by clinical features and family history as type 1, and 16 (15.1%) type 2. For type 1 subjects, age range at diagnosis was 0.9-19.9 year (y), peak age of onset 12-13 year, and 3.3% were < 5 year, 21.1% 5- < 10 year, 45.6% 10- < 15 year and 30.0% 15- < 20 year. Seventy-one point one percent were female. Common clinical features were polyuria (100%), polydipsia (98.9%), and weight loss (82.2%). Mean BMI SD was -0.54, range -3.84 to 2.47. 60.0% presented in diabetic ketoacidosis (DKA). Nine had infections at onset (skin, abscess, leg ulcer). Mean ± SD HbA1c at diagnosis was 12.7% ± 1.9% (115 ± 21 mmol/mol). Four have since died: Hypoglycaemia (2), recurrent DKA (1), osteosarcoma (1). Two other type 1 cases died of DKA at presentation in emergency before being seen by the paediatric endocrinologist. Crude mortality rate including these 2 cases was 32.2/1000 patient years. Type 2 cases were 81% female, age of onset 9-19 year. Mean BMI SD was 1.49, range -0.87 to 2.61. Forty-three point eight percent presented in DKA. All type 2 cases had acanthosis nigricans. Overall, 9.8% did not have home refrigeration, most using clay pot evaporative cooling for insulin storage.CONCLUSIONType 1 occurs with a female preponderance and high DKA rates. Type 2 also occurs. Typology based on clinical features is difficult. Community and professional awareness is warranted.

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Ketosis‐prone atypical diabetes in Cameroonian people with hyperglycaemic crisis: frequency, clinical and metabolic phenotypes

Abstract: Ketosis-prone diabetes is likely to be a subtype of Type 2 diabetes with the potential to develop acute insulinopenic episodes.

Cited by 23 publications

References 18 publications

Circulating osteocalcin: A potential predictor of ketosis in type 2 diabetes

Circulating osteocalcin: A potential predictor of ketosis in type 2 diabetes

Clinical profile of diabetes at diagnosis among children and adolescents at an endocrine clinic in Ghana

Clinical profile of diabetes at diagnosis among children and adolescents at an endocrine clinic in Ghana

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