Narrative review: ketosis-prone type 2 diabetes mellitus.

Abstract

Several investigators have reported that more than half of African-American persons with new diagnoses of diabetic ketoacidosis have clinical, metabolic, and immunologic features of type 2 diabetes during follow-up. These patients are usually obese, have a strong family history of diabetes, have a low prevalence of autoimmune markers, and lack a genetic association with HLA. Their initial presentation is acute, with a few days to weeks of polyuria, polydipsia, and weight loss and lack of a precipitating cause of metabolic decompensation. At presentation, they have markedly impaired insulin secretion and insulin action, but intensified diabetic management results in significant improvement in beta-cell function and insulin sensitivity sufficient to allow discontinuation of insulin therapy within a few months of follow-up. On discontinuation of insulin therapy, the period of near-normoglycemic remission may last for a few months to several years. The absence of autoimmune markers and the presence of measurable insulin secretion have proven useful in predicting near-normoglycemic remission and long-term insulin dependence in adult patients with a history of diabetic ketoacidosis. This clinical presentation is commonly reported in African and African-American persons but is also observed in Hispanic persons and those from other minority ethnic groups. The underlying mechanisms for beta-cell dysfunction in ketosis-prone type 2 diabetes are not known; however, preliminary evidence suggests an increased susceptibility to glucose desensitization.

• Authors: Guillermo E Umpierrez, Dawn Smiley, Abbas E Kitabchi
• Journal: Annals of internal medicine (Ann Intern Med) Vol. 144 Issue 5 Pg. 350-7 (Mar 07 2006) ISSN: 1539-3704 [Electronic] United States
• PMID: 16520476 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Insulin

Topics

• Adult
• Black People (genetics)
• Diabetes Mellitus, Type 2 (diet therapy, epidemiology, genetics, metabolism)
• Hispanic or Latino (genetics)
• Humans
• Insulin (therapeutic use)
• Obesity (complications, therapy)
• Prevalence
• United States (epidemiology)