Should diabetic ketosis without acidosis be included in ketosis-prone type 2 diabetes mellitus?

Abstract

BACKGROUND:

The incidence of ketosis-prone type 2 diabetes is very low except for people of sub-Saharan African origin and African Americans. However, there also are some type 2 diabetes patients with diabetic ketosis without acidosis (DKWA). We question whether DKWA should be included as a subtype of ketosis-prone type 2 diabetes mellitus and compared the clinical characteristics of DKWA and diabetic ketoacidosis (DKA) patients.

METHODS:

The study population consisted of 594 consecutive unrelated Chinese inpatients with newly diagnosed type 2 diabetes. Demographic and clinical characteristics (age, gender, family history of diabetes, body mass index, blood pressure and plasma lipid parameters) were recorded. The patients were divided into ketosis-resistant diabetes (KRD), DKWA and DKA groups on the basis of urinary ketones, blood pH and bicarbonate levels. The blood glucose and c-peptide levels of the patients were also evaluated.

RESULTS:

The prevalence of KRD, DKWA and DKA were 78.33%, 19.72% and 1.95%, respectively, in the study population. The clinical characteristics of patients with DKWA group patients were similar to those with DKA, except that DKA patients had higher blood glucose and deteriorated β cell function.

CONCLUSIONS:

Diabetic ketosis without acidosis and DKA patients share similar clinical characteristics; DKWA should be considered ketosis-prone type 2 diabetes. Therefore, the prevalence of ketosis-prone type 2 diabetes might be underestimated.

• Authors: Xiao-Jing Xie, Yun Hu, Cheng Cheng, Tian-Tian Feng, Ke He, Xiao-Ming Mao
• Journal: Diabetes/metabolism research and reviews (Diabetes Metab Res Rev) Vol. 30 Issue 1 Pg. 54-9 (Jan 2014) ISSN: 1520-7560 [Electronic] England
• PMID: 24038858 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2013 John Wiley & Sons, Ltd.

Chemical References

• Blood Glucose
• C-Peptide

Topics

• Acidosis (epidemiology)
• Adult
• Blood Glucose (metabolism)
• C-Peptide (metabolism)
• China (epidemiology)
• Comorbidity
• Diabetes Mellitus, Type 1 (diagnosis, epidemiology, metabolism)
• Diabetes Mellitus, Type 2 (diagnosis, epidemiology, metabolism)
• Diagnosis, Differential
• Female
• Humans
• Incidence
• Male
• Middle Aged
• Prevalence
• Sex Distribution
• Sex Factors