Pathophysiology of ketoacidosis in Type 2 diabetes mellitus

Linfoot, Peter A.; Bergstrom, Colin P.; Ipp, Eli

doi:10.1111/j.1464-5491.2005.01660.x

Cited by 37 publications

(33 citation statements)

References 31 publications

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“…Indeed, patients presenting with diabetic ketoacidosis in Europe usually have type 1A diabetes; of 4807 patients admitted with ketosis-prone diabetes (KPD) in Denmark between 1996 and 2002, only 12% were subsequently classified with type 2 diabetes [5]. Not everyone with diabetic ketoacidosis is young, has autoimmune features or, with time, turns out to be insulin-dependent [6][7][8][9][10][11]. The lack of flexibility in the current classification system fails to pigeonhole these cases.…”

Section: Have No Name For That! Feeling Is All In All;mentioning

confidence: 96%

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Diabetes classification: grey zones, sound and smoke: Action LADA 1

Leslie

Kolb

Schloot

et al. 2008

Diabetes Metabolism Res

123

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Diseases gain identity from clinical phenotype as well as genetic and environmental aetiology. The definition of type 1 diabetes is clinically exclusive, comprising patients who are considered insulin dependent at diagnosis, whilst the definition of type 2 diabetes is inclusive, only excluding those who are initially insulin dependent. Ketosis-prone diabetes (KPD) and latent autoimmune diabetes in adults (LADA) are each exclusive forms of diabetes which are, at least initially, clinically distinct from type 2 diabetes and type 1 diabetes, and each have a different natural history from these major types of diabetes.KPD can be diagnosed unequivocally as diabetes presenting with the categorical clinical feature, ketoacidosis. In contrast, LADA can be diagnosed by the co-occurrence of three traits, not one of which is categorical or exclusive to the condition: adult-onset non-insulin-requiring diabetes, an islet autoantibody such as glutamic acid decarboxylase autoantibodies (GADA) or cytoplasmic islet cell autoantibodies (ICA), and no need for insulin treatment for several months post-diagnosis. But while some would split diabetes into distinct subtypes, there is a strong case that these subtypes form a continuum of varying severity of immune and metabolic dysfunction modified by genetic and non-genetic factors. This article discusses the nature of disease classification in general, and KPD and LADA in particular, emphasizing the potential value and pitfalls in classifying diabetes and suggesting a need for more research in this area.

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Section: Have No Name For That! Feeling Is All In All;mentioning

confidence: 96%

“…Patients with KPD have severe insulin deficiency at presentation, but can subsequently recover their insulin secretion [6,11,12]. LADA patients, in comparison with type 1 diabetes, have higher insulin levels [54].…”

Section: Insulin Secretion and Sensitivitymentioning

confidence: 99%

Diabetes classification: grey zones, sound and smoke: Action LADA 1

Leslie

Kolb

Schloot

et al. 2008

Diabetes Metabolism Res

123

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“…However, the mean BMI as well as the triglycerides were lower in our patients than levels reported in other studies [13,14], probably because of a lower rate of insulin resistance in our population. Moreover, the presence of the metabolic syndrome is more frequently associated with preserved β-cell function, and consequently a better glycaemic control after the acute episode and long-term remission [14,15]. In this kind of type 2 diabetes, the acute β-cell failure inducing ketosis [15] seems to be linked to a genetic propensity to glucotoxicity and lipotoxicity [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the presence of the metabolic syndrome is more frequently associated with preserved β-cell function, and consequently a better glycaemic control after the acute episode and long-term remission [14,15]. In this kind of type 2 diabetes, the acute β-cell failure inducing ketosis [15] seems to be linked to a genetic propensity to glucotoxicity and lipotoxicity [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Ketosis-onset diabetes in Tunisian adults: immunological markers and beta-cell function

Harzallah¹,

Brahim²,

Laadhar³

et al. 2010

East Mediterr Health J

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The aim of this study in Tunisia was to classify ketosis-onset diabetes in adult patients. All patients aged ≥ 30 years without known diabetes, presenting with ketosis and admitted to our department were studied. Patients with secondary or gestational diabetes and those on corticoid therapy or with coinciding infection were excluded. The data included clinical characteristics, immunological markers and β-cell function. Of the 63 patients, islet-cell antibodies were present in 27.0%, glutamic acid decarboxylase antibodies in 25.4% and thyrosin phosphatase antibodies in 19.0%. β-cell functional reserve was preserved in 54.0%. Our results confirm that patients with ketosis-onset diabetes mellitus in adulthood are a heterogeneous group.

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“…In the largest study of DKA in type 2 diabetics, Linfoot 11 found, using c-peptide concentration as a marker for insulin, a significant decrease in plasma…”

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confidence: 99%

Clinical profile of diabetic ketoacidosis in adults

et al. 2012

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Introduction: Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Recent epidemiological studies indicate that hospitalizations for DKA in the U.S. are increasing. Epidemiological studies from India are limited. We undertook this observational study to analyse the clinical profiles of DKA in adults in south India. Methods: This study was conducted in at a tertiary care center in Andhra Pradesh for one year from Aug 2010 to July 2011. Diagnosis of DKA was made by the presence of (1) Plasma glucose level of 250mg/dl or higher (2) Serum bicarbonate level of 15mEq/lt or lower (3) Arterial blood pH of 7.3 or lower or a venous blood pH of 7.25 or lower (4) Presence of moderate or large urine ketones. All the patients were treated with institutional treatment protocol. Results: Of 27 patients, 22(81%) had type2 diabetes and 5(19%) had type 1 DM .10 were females and 17 males. Age of the patients ranged between 18 to 70 years, with an average of 45.3 years. Precipitating factors were present in 60% of the admissions. Non-compliance or discontinuation of drug therapy was seen in fifty per cent of patients. Average length of hospital stay was slightly longer in type 1 than type 2 DM patients Conclusion: A significant proportion of DKA occurs in patients with type 2 diabetes and many of these cases can be prevented with proper patient education and effective communication with a health care provider during an inter-current illness.

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Pathophysiology of ketoacidosis in Type 2 diabetes mellitus

Abstract: At the time of hospital presentation, the predominant mechanism for ketosis in KPDM2 is likely to be greater insulinopenia.

Cited by 37 publications

References 31 publications

Diabetes classification: grey zones, sound and smoke: Action LADA 1

Diabetes classification: grey zones, sound and smoke: Action LADA 1

Ketosis-onset diabetes in Tunisian adults: immunological markers and beta-cell function

Clinical profile of diabetic ketoacidosis in adults

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