Update on diagnosis, pathogenesis and management of ketosis-prone Type 2 diabetes mellitus

Abstract

SUMMARY Diabetic ketoacidosis (DKA) has been considered a key clinical feature of Type 1 diabetes mellitus; however, increasing evidence indicates that DKA is also a common feature of Type 2 diabetes (T2DM). Many cases of DKA develop under stressful conditions such as trauma or infection but an increasing number of cases without precipitating cause have been reported in children and adults with T2DM. Such patients present with severe hyperglycemia and ketosis as in Type 1 diabetes mellitus but can discontinue insulin after a few months and maintain acceptable glycemic control on diet or oral agents. This subtype of diabetes has been referred to as ketosis-prone T2DM. In this article, we reviewed the literature on ketosis-prone T2DM and summarized the epidemiology, putative pathophysiology and approaches to management.

Diabetes Mellitus tipo 2 con tendencia a la cetosis: Caso clínico

“…Actualmente la DTC es reconocida en todas las poblaciones. Así, en Norteamé-rica se ha informado que también se presenta en hispanos (20-50%) y aproximadamente en 10% de los asiáticos y blancos 7,8 . Nosotros publicamos en el año 2001 un grupo de pacientes que correspondería a este subtipo de DM2 9 .…”

“…La mayoría de los pacientes tienen un síndrome diabético agudo 4 a 6 semanas previas a su diagnóstico, y el examen físico frecuentemente muestra marcadores de RI (acantosis nigricans y obesidad abdominal). Al debut presentan características clínicas y pará-metros bioquímicos y ácido base de una CAD, sin causa precipitante 8 . Se deben tratar de acuerdo a los protocolos recomendados para el manejo de la CAD 20 , con reposición agresiva de fluidos, insulinoterapia continua, vigilancia y tratamiento de los desórdenes electrolíticos y ácido base.…”

When to suspect ‘funny’ diabetes

“…9 This means that they may intermittently be at risk of ketoacidosis and require insulin therapy, whereas at other times they are able to manage their diabetes with just oral hypoglycaemic agents or even diet alone. Ketosis-prone type 2 diabetes is more common in patients from an Afro-Caribbean ethnic background.…”

Advancing clinical care for the patients with ketosis-prone diabetes: from knowledge to action

“…Majority of KPD patients are classified as "A − β+" since they do not have islet cell antibodies (A−) but demonstrate substantial β-cell reserve (β+) and frequently identified in the literature as ketosis-prone type 2 diabetes (Umpierrez, Smiley, & Kitabchi, 2006). These patients are often obese and middle-aged and have no prior history of diabetes at the time of evaluation for new-onset severe hyperglycemia and ketosis (Smiley, Chandra, & Umpierrez, 2011). The courses of "A − β+" KPD and treatment outcomes are well described in the literature.…”

“…The courses of "A − β+" KPD and treatment outcomes are well described in the literature. These patients will achieve near-normoglycemic remission within 2-3 months of commencement of intensive insulin therapy, however 40-60% of the patients will develop hyperglycemic relapse following the discontinuation of insulin therapy while managed by diet and oral hypoglycemic agents (Banerji, Chaiken, & Lebovitz, 1995;Mauvais-Jarvis, Sobngwi, Porcher, et al, 2004;Smiley et al, 2011). Despite the fact that significant number of the "A − β+" KPD patients remain at high risk for relapse, there are no data to help providers identify risk factors associated with hyperglycemia recurrence.…”