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Atypical Ketosis Prone Diabetes

Ketosis-prone Type 2 Diabetes Mellitus

Ketosis-prone Type 2 Diabetes Mellitus

Ketosis-Prone Type 2 Diabetes Mellitus Many newly diagnosed African A Many newly diagnosed African Americans with diabetic ketoacidosis (DKA) display clinical, metabolic, and immunological features of type 2 diabetes. Their initial presentation is acute and without precipitating cause. Most patients are able to discontinue insulin therapy within a few weeks/months of follow-up. The clinical presentation affects 20-50% of newly diagnosed Black and Hispanic patients with DKA. This subtype of diabetes is referred to as diabetes type 1B, atypical diabetes, and more recently as ketosis-prone type 2 diabetes (KPDM). We reviewed current knowledge regarding the clinical presentation, metabolic and immunologic features of subjects with this [apos]atypical[apos] form of diabetes. We performed a computerized search of biomedical journal literature from Medline, PubMed and Ovid from 1/1966 to 10/2005. English-language original articles found under the subject headings [apos]ketosis-prone type 2 diabetes[apos] and [apos]atypical diabetes[apos] were reviewed. In this analysis we included 907 cases (666 Blacks, 158 Hispanics, 60 Caucasians, 20 Asians, and 3 Native Americans) from 18 series reported from America, Europe, Africa, and Asia. Clinical characteristic include a mean age 41 [plusmn] 5 years, male gender: 67%[plusmn]9, new onset diabetes: 89%, % family history: 76[plusmn]14, % positive antibodies: 3.5[plusmn]5, % patients who attained remission: 70 [plusmn] 22, A1C at presentation: 12.7[plusmn]1.0 %, and A1C at remission: 7.2[plusmn]1.0%. At presentation, they have markedly impaired insulin secretion and insulin action, but intensified treatment improves b-cell function and insulin sensitivity during follow-up. Determination of autoimmune markers (ICA and GAD antibodies) and Continue reading >>

Atypical Diabetes In Children: Ketosis-prone Type 2 Diabetes.

Atypical Diabetes In Children: Ketosis-prone Type 2 Diabetes.

Atypical diabetes in children: ketosis-prone type 2 diabetes. 1.Department of Paediatrics, Bradford Royal Infirmary, Bradford, West Yorkshire, UK. [email protected] Ketosis-prone type 2 diabetes mellitus also known as atypical or flatbush diabetes is being increasingly recognised worldwide. These patients are typically obese, middle-aged men with a strong family history of type 2 diabetes. The aetiology and pathophysiological mechanism is still unclear but some initial research suggests that patients with ketosis-prone type 2 diabetes have a unique predisposition to glucose desensitisation. These patients have negative autoantibodies typically associated with type 1 diabetes but have shown to have human leucocyte antigen (HLA) positivity. At initial presentation, there is an impairment of both insulin secretion and action. Cell function and insulin sensitivity can be markedly improved by initiating aggressive diabetes management to allow for discontinuation of insulin therapy within a few months of treatment. These patients can be maintained on oral hypoglycaemic agents and insulin therapy can be safely discontinued after few months depending on their cell function. Continue reading >>

Ketosis-onset Diabetes And Ketosis-prone Diabetes: Same Or Not?

Ketosis-onset Diabetes And Ketosis-prone Diabetes: Same Or Not?

Ketosis-Onset Diabetes and Ketosis-Prone Diabetes: Same or Not? Endocrinology and Metabolism Department of the Second Hospital Affiliated to Harbin Medical University, Harbin Medical University, Harbin, Heilongjiang Province 150086, China Received 1 March 2013; Revised 3 April 2013; Accepted 3 April 2013 Copyright 2013 Beiyan Liu et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. To compare clinical characteristics, immunological markers, and -cell functions of 4 subgroups (A classification system) of ketosis-onset diabetes and ketosis prone diabetes patients without known diabetes, presenting with ketosis or diabetic ketoacidosis (DKA) and admitted to our department from March 2011 to December 2011 in China, with 50 healthy persons as control group. Results. -cell functional reserve was preserved in 63.52% of patients. In almost each subgroup (except A subgroup of ketosis prone group), male patients were more than female ones. The age of the majority of patients in ketosis prone group was older than that of ketosis-onset group, except A subgroup of ketosis prone group. The durations from the patient first time ketosis or DKA onset to admitting to the hospital have significant difference, which were much longer for the ketosis prone group except the A+ + subgroup. BMI has no significant difference among subgroups. FPG of ketosis prone group was lower than that of A + subgroup and A+ + subgroup in ketosis-onset group. A subgroup and A+ + subgroup of ketosis prone group have lower HbA1c than ketosis-onset group. Conclusions. Ketosis-onset diabetes and ketosis prone diabetes do not absolutely Continue reading >>

Ketosis-prone Diabetesa New Subgroup Of Patients With Atypical Type 1 And Type 2 Diabetes?

Ketosis-prone Diabetesa New Subgroup Of Patients With Atypical Type 1 And Type 2 Diabetes?

Ketosis-Prone DiabetesA New Subgroup of Patients with Atypical Type 1 and Type 2 Diabetes? Division of Endocrinology, Diabetes and Metabolism, Department of Medicine University of Tennessee College of Medicine Memphis, Tennessee 38163 Address all correspondence and requests for reprints to: Abbas E. Kitabchi, Ph.D., M.D., Division of Endocrinology, University of Tennessee College of Medicine, 951 Court Avenue, Room 335M, Memphis, Tennessee 38163. Search for other works by this author on: The Journal of Clinical Endocrinology & Metabolism, Volume 88, Issue 11, 1 November 2003, Pages 50875089, Abbas E. Kitabchi; Ketosis-Prone DiabetesA New Subgroup of Patients with Atypical Type 1 and Type 2 Diabetes?, The Journal of Clinical Endocrinology & Metabolism, Volume 88, Issue 11, 1 November 2003, Pages 50875089, One objective for classification of a disease is the opportunity to study its epidemiology, etiology, and pathogenesis to provide various effective interventions for its prevention and treatment. The paper of Maldonado et al. ( 1 ) in this issue of JCEM reports on the classification of four groups of diabetic patients who presented with diabetic ketoacidosis (DKA). Of the two most common types of hyperglycemic crises, DKA most often occurs in type 1 diabetes (DM-1), and hyperglycemic hyperosmolar state most frequently arises in type 2 diabetes (DM-2). However, the occurrence of these acute metabolic emergencies is not specific to one type of diabetes or the other ( 2 ). Maldonado et al. ( 1 ) have carefully and meticulously studied a well-defined multiethnic group of patients with diabetes who presented with DKA. The study cohort was divided into four groups based on positive or negative -cell insulin function (B+ or B, respectively), as well as positive or negative au Continue reading >>

Afmr - Acute Phase Ketosis-prone Atypical Diabetes Is Associated With A Pro-inflammatory Profile: A Case-control Study In A Sub-saharan African Population

Afmr - Acute Phase Ketosis-prone Atypical Diabetes Is Associated With A Pro-inflammatory Profile: A Case-control Study In A Sub-saharan African Population

Acute phase ketosis-prone atypical diabetes is associated with a pro-inflammatory profile: a case-control study in a sub-Saharan African population Eric Lontchi-Yimagou1, Philippe Boudou2, Jean Louis Nguewa2, Jean Claude Mbanya3, Jean-Francois Gautier2, Eugene Sobngwi3 1Medicine, Diabetes Research and Training Center, Albert Einstein College of Medicine, Bronx, New York, Bronx, New York, United States, 2INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France, 3National Obesity Centre, Yaound Central Hospital, Yaound, Cameroon Purpose of Study It is unknown whether inflammation plays a role in the metabolic dysfunction in ketosis-prone diabetes (KPD). We aimed to assess the inflammatory profile in sub-Saharan African patients with KPD during the acute ketotic phase as well as during non-ketotic hyperglycemic crises. Methods Used We studied 72 patients with non-autoimmune diabetes: 23 with type 2 diabetes mellitus (T2D), and 49 with KPD, all admitted in hyperglycemic crisis (plasma glucose > 250 mg/dl). The T2D and KPD groups were matched by sex, age, and Body Mass Index. KPD was sub-classified into new-onset ketotic phase (n=34) or non-ketotic phase (n=15). We measured TNF-, MCP-1, MIP1-, IL-8, MIP1-, and VEGF in the serum of all participants during the acute hyperglycemic crisis. Summary of Results TNF- and IL-8 were higher in participants with KPD compared to those with T2D (p=0.02 TNF-; p=0.03 IL-8). TNF- and IL-8 were also higher in the ketotic phase KPD group compared to the T2D group (p=0.03 TNF-; p<0.001 IL-8) while MIP1- was lower in people with ketotic phase KPD compared to their T2D counterparts (p=0.03). MIP1- was lower in the ketotic phase KPD group compared to the non-ketotic phase KPD group (p=0.04). MCP-1 was lower in non-ketotic phase KPD co Continue reading >>

Ketosis-prone Type 2 Diabetes

Ketosis-prone Type 2 Diabetes

Background The original schema for classifying diabetes mellitus (DM) consisted of 2 categories known as type 1 diabetes mellitus and type 2 diabetes mellitus. Type 1 diabetes was also known as insulin-dependent diabetes. Patients with this type of diabetes were considered prone to develop diabetic ketoacidosis (DKA). Patients with type 1 diabetes were found to have an absolute insulin deficiency due to autoimmune destruction of pancreatic beta cells. Patients with type 2 diabetics, or noninsulin-dependent diabetes, were not considered to be at risk for DKA. Type 2 diabetes is strongly associated with obesity and a family history of diabetes. These patients have peripheral insulin resistance with initially normal or elevated circulating levels of endogenous insulin. Practice Essentials Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. See the image below. See Clinical Findings in Diabetes Mellitus, a Critical Images slideshow, to help identify various cutaneous, ophthalmologic, vascular, and neurologic manifestations of DM. Signs and symptoms Many patients with type 2 diabetes are asymptomatic. Clinical manifestations include the following: See Presentation for more detail. Diagnosis Diagnostic criteria by the American Diabetes Association (ADA) include the following [1] : Whether a hemoglobin A1c (HbA1c) level of 6.5% or higher should be a primary diagnostic criterion or an optional criterion remains a point of controversy. Indications for diabetes screening in asymptomatic adults includes the following [2, 3] : Overweight and 1 or more other risk factors for diabetes (eg, first-d Continue reading >>

Association Of Hla Class Ii Markers With Autoantibody-negative Ketosis-prone Atypical Diabetes Compared To Type 2 Diabetes In A Population Of Sub-saharan African Patients

Association Of Hla Class Ii Markers With Autoantibody-negative Ketosis-prone Atypical Diabetes Compared To Type 2 Diabetes In A Population Of Sub-saharan African Patients

Volume 107, Issue 1 , January 2015, Pages 31-36 Association of HLA class II markers with autoantibody-negative ketosis-prone atypical diabetes compared to type 2 diabetes in a population of sub-Saharan African patients We investigated the association of HLA DRB1 and DQB1 alleles, haplotypes and genotypes with unprovoked antibody-negative ketosis-prone atypical diabetes (A KPD) in comparison to type 2 diabetes (T2D). A KPD and T2D sub-Saharan African patients aged 1963 years were consecutively recruited. Patients positive for cytoplasmic islet cell, insulin, glutamic acid decarboxylase or islet antigen-2 autoantibodies were excluded. Odds ratios were obtained via logistic regression after considering alleles with a minimum frequency of 5% in the study population. Bonferroni correction was used in the case of multiple comparisons. Among the 130 participants, 35 (27%) were women and 57 (44%) were A KPD. DRB1 and DQB1 allele frequencies were similar for both A KPD and T2D patients; they did not confer any substantial risk even after considering type 1 diabetes susceptibility and resistance alleles. We found no association between A KPD and the derived DRB1*07-DQB1*02:02 (OR: 0.55 [95%CI: 0.171.85], P=0.336); DRB1*11-DQB1*03:01 (OR: 2.42 [95%CI: 0.797.42], P=0.123); DRB1*15-DQB1*06:02 (OR: 0.87 [95%CI: 0.391.95], P=0.731) and DRB1*03:01-DQB1*02:01 (OR: 1.48 [95%CI: 0.553.96], P=0.437) haplotypes. Overall, we did not find any evidence of susceptibility to ketosis associated with DRB1 and DQB1 genotypes (all P>0.05) in A KPD compared to T2D. Similar results were obtained after adjusting the analysis for age and sex. Factors other than DRB1 and DQB1 genotype could explain the propensity to ketosis in A KPD. These results need to be confirmed in a larger population with the per Continue reading >>

Syndromes Of Ketosis-prone Diabetes Mellitus

Syndromes Of Ketosis-prone Diabetes Mellitus

INTRODUCTION Since the mid-1990s, increasing attention has been focused on a heterogeneous condition characterized by presentation with diabetic ketoacidosis (DKA) in patients who do not necessarily fit the typical characteristics of autoimmune type 1 diabetes. Earlier reports used the terms "atypical diabetes," "Flatbush diabetes," "diabetes type 1B," and "ketosis-prone type 2 diabetes mellitus" to describe subsets of this condition, and it was noted that in some instances patients presented with DKA as the first manifestation of diabetes and evolved to insulin independence [1]. While initially these reports suggested that the condition, now termed ketosis-prone diabetes (KPD), might be limited to persons of non-Caucasian ethnicity, its prevalence appears to be increasing in a wide range of ethnic groups worldwide [2-5]. The classification, pathophysiology, natural history, and management of KPD will be reviewed here. Patients with islet autoantibodies who do not present with ketosis, including those termed "latent autoimmune diabetes in adults" (LADA), "type 1.5 diabetes" [6,7], and "slowly progressing type 1 diabetes" [8] are discussed elsewhere. (See "Classification of diabetes mellitus and genetic diabetic syndromes".) CLASSIFICATION OF KPD The goal of new classification schemes is to enable clinicians to predict which patients with diabetic ketoacidosis (DKA) require temporary insulin treatment versus life-long insulin therapy. They also highlight subgroups for genetic and pathogenetic studies. Ketosis-prone diabetes (KPD) comprises a group of diabetes syndromes characterized by severe beta cell dysfunction (manifested by presentation with DKA or unprovoked ketosis) and a variable clinical course. These syndromes do not fit the traditional categories of diabetes d Continue reading >>

Ketosis Prone Type 2 Diabetes - General Practice Notebook

Ketosis Prone Type 2 Diabetes - General Practice Notebook

Ketosis prone type 2 diabetes/atypical diabetes/flatbush diabetes is a widespread, emerging, heterogeneous syndrome characterised by patients who present with diabetic ketoacidosis (DKA) or unprovoked ketosis with hyperglycaemia but do not necessarily have the typical phenotype of autoimmune type 1 diabetes is an uncommon form of diabetes characterized by severe reversible insulin deficiency atypical diabetes was originally described by Banerji et al as a unique form of diabetes among African-American patients who presented with DKA as their initial manifestation of diabetes (1) ketosis prone type 2 diabetes, though first described and mostly observed in males of African-American descent, has been identified in Asian populations, including Japanese and Chinese there is an increased male preponderance in this condition in a South African study, half the presentations of DKA were due to type 2 diabetes (2) at initial presentation, the patients with type 2 diabetes and DKA cannot be reliably separated from those with type 1 diabetes; however, they tend to be middle-aged, obese, hypertensive and may have markers of insulin resistance such as acanthosis nigricans (2) often a positive family history of type 2 diabetes mechanism underlying their presentation seems to be the combination of insensitivity to insulin and transient loss of ability to release adequate amounts of insulin in contrast to type 1 diabetes, patients with atypical diabetes undergo spontaneous remission and maintain long-term insulin independence (1,3) during admission the patients with type 2 diabetes gradually lose their insulin resistance patients with ketosis prone type 2 diabetes do not have the autoantibodies associated with type 1 diabetes and they have recovery of insulin secretion as evidenced by Continue reading >>

Omim Entry - # 612227 - Diabetes Mellitus, Ketosis-prone; Kpd

Omim Entry - # 612227 - Diabetes Mellitus, Ketosis-prone; Kpd

A number sign (#) is used with this entry because of evidence that susceptibility to ketosis-prone diabetes mellitus is conferred by homozygous mutation in the PAX4 gene ( 167413 ) on chromosome 7q32. One patient has been found to be heterozygous for mutation in PAX4. In addition to classic type 1 (see 222100 ) and type 2 (see 125853 ) diabetes mellitus, atypical presentations are seen, particularly in populations of African ancestry. Ketosis-prone diabetes, the most common atypical form, is characterized by an acute initial presentation with severe hyperglycemia and ketosis, as seen in classic type 1 diabetes, but after initiation of insulin therapy, prolonged remission is often possible with cessation of insulin therapy and maintenance of appropriate metabolic control. Metabolic studies show a markedly blunted insulin secretory response to glucose, partially reversible with the improvement of blood glucose control. Variable levels of insulin resistance are observed, especially in obese patients. Pancreatic beta-cell autoimmunity is a rare finding, and association with type 1 susceptibility HLA alleles is variable ( Sobngwi et al., 2002 ). Maldonado et al. (2003) studied 103 patients with diabetic ketoacidosis (DKA), classifying them into 4 groups according to the presence or absence of autoimmune markers for type 1 diabetes (A+ or A-) and the presence or absence of beta-cell functional reserve (beta+ or beta-). There were 18 patients in the A+beta- group, 23 in the A-beta- group, 11 in the A+beta+ group, and 51 in the A-beta+ group. Collectively, the 2 beta- groups differed from the 2 beta+ groups in earlier onset and longer duration of diabetes, lower body mass index (BMI), less glycemic improvement, and persistent insulin requirement. HLA class II genotyping showed Continue reading >>

Ketosis-prone Diabetes

Ketosis-prone Diabetes

Does presenting with diabetic ketoacidosis (DKA) mandate indefinite insulin treatment? Not always. Since the mid-1990s, weve increasingly observed and recognized patients that dont neatly fit into either type 1 diabetes (T1DM) or T2DM. Ketosis-prone type 2 diabetes mellitus (KPDM) is underrecognized and distinctive. First described by Winter and colleagues in 1987, 12 African-American patients initially presented with DKA, but their disease course unfolded more like that of an individual with T2DM.1 KPDM was initially thought to be a variant of maturity onset diabetes of the young (MODY). Other names include Flatbush diabetes (named for the part of Brooklyn, NY where young African-Americans were described to have these clinical features of KPDM), type 1.5 diabetes, and atypical diabetes. 1. A large number of KPDM patients present without a previous diagnosis of DM and without a known precipitating cause for the DKA. >75% of KPDM patients fit this description. Most patients are African-American or Hispanic, overweight or obese, male (theres a two- to three-fold greater prevalence in men compared with women), in their 40s or 50s at the time of diagnosis. 2. If the patients insulin requirements rapidly decline in the first several weeks after presenting, think of possible KPDM. i. Patients test pre-meal glucose at least 2 times/day, and check in with their health care professional team every 2 weeks for the first 2 months after being discharged from the hospital to titrate insulin, and subsequently every 2 or 3 months, as extent of control warrants. ii.Clinicians begin tapering insulin by 25% at each visit, once fasting glucose declines below 130 mg/dL for 2 weeks, or if the patient develops hypoglycemia. 3. Many patients with KPDM will spontaneously remit. Most patients Continue reading >>

Ketosis-prone Type 2 Diabetes

Ketosis-prone Type 2 Diabetes

Time to revise the classification of diabetes Diabetic ketoacidosis (DKA) is the most serious hyperglycemic emergency in patients with diabetes. DKA is reported to be responsible for >100,000 hospital admissions per year in the U.S. (1) and is present in 25–40% of children and adolescents with newly diagnosed diabetes (2) and in 4–9% of all hospital discharge summaries among adult patients with diabetes (3,4). DKA has long been considered a key clinical feature of type 1 diabetes, an autoimmune disorder characterized by severe and irreversible insulin deficiency. In recent years, however, an increasing number of ketoacidosis cases without precipitating cause have also been reported in children, adolescents, and adult subjects with type 2 diabetes (5–7). These subjects are usually obese and have a strong family history of diabetes and a low prevalence of autoimmune markers. At presentation, they have impairment of both insulin secretion and insulin action, but aggressive diabetes management results in significant improvement in β-cell function and insulin sensitivity sufficient to allow discontinuation of insulin therapy within a few months of treatment (7–9). Upon discontinuation of insulin, the period of near-normoglycemic remission may last for a few months to several years (10–13). This clinical presentation has been reported primarily in Africans and African Americans (6,7,14–16) and also in other minority ethnic groups (12,17,18). This variant of type 2 diabetes has been referred to in the literature as idiopathic type 1 diabetes, atypical diabetes, Flatbush diabetes, diabetes type 1 (1/2) (somewhere between type 1 and type 2 diabetes), and more recently as ketosis-prone type 2 diabetes (9). In this issue of Diabetes Care, Balasubramayam et al. (19) co Continue reading >>

Male Predominance In Ketosisprone Diabetes Mellitus (review)

Male Predominance In Ketosisprone Diabetes Mellitus (review)

Male predominance in ketosisprone diabetes mellitus (Review) Affiliations: Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China Published online on: May 8, 2015 Metrics: HTML 0 views | PDF 0 views Cited By (CrossRef): 0 citations The incidence of ketosisprone diabetes mellitus (KPDM) shows a higher prevalence in men. The clear male predominance of this syndrome and its underlying pathogenesis mechanisms are unclear. KPDM, once described as atypical diabetes mellitus, idiopathetic type1 diabetes (type1B diabetes) and flatbush diabetes, is an uncommon form of diabetes characterized by severe reversible insulin deficiency. KPDM was first described and mostly observed in males of AfricanAmerican descent and recently in Asian populations, including Japanese and Chinese. Patients with KPDM often present acutely with diabetic ketoacidosis without any immunological autoantibody to islet antigens of classic type1 diabetes but demonstrate clinical and metabolic features of type2 diabetes. Accumulating data indicated that genderrelated body fat distribution, hormonal and genetic factors are associated with the diabetic process and the human glucose homeostasis and metabolism. A controversial question is whether and to what degree those factors contribute to the phenomenon of male predominance in KPDM. The present review focuses on the role of gender hormones and other potential precipitating factors in explaining the male predominance in KPDM patients. Recent evidence indicates that ketosis-pronediabetes mellitus (KPDM), which was once described as atypicaldiabetes mellitus, idiopathetic type 1 diabetes (type 1B diabetes)or flatbush diabetes, shows a 2- or 3-fold higher prevalence in mencompared to women ( 1 5 Continue reading >>

Atypical Ketosis-prone Diabetes

Atypical Ketosis-prone Diabetes

S. Ali Imran , MB BS FRCP FRCPC and Ehud Ur , MB BS FRCP Dr Imran is an Associate Professor and Dr Ur is a Professor in the Division of Endocrinology and Metabolism at Dalhousie University in Halifax, NS Correspondence: Dr S.A. Imran, Division of Endocrinology and Metabolism, Dalhousie University, 7th Floor, North Victoria Building, VG Site, 1278 Tower Rd, Halifax, NS B3H 2Y9; telephone 902 473-8277; fax 902 473-3726; e-mail [email protected] Copyright the College of Family Physicians of Canada This article has been cited by other articles in PMC. Atypical diabetes is a rare form of diabetes mellitus (DM) that presents with diabetic ketoacidosis (DKA). However, in contrast to type 1 DM, patients with atypical DM undergo spontaneous remission and maintain long-term insulin independence. Family physicians must maintain a high index of suspicion to diagnose and manage such cases. A 44-year-old, previously healthy South Asian woman presented to her family physician with progressively worsening dry mouth, polyuria, and polydipsia for 6 weeks. She had also lost 7 kg in weight over the past 3 months. At the time of initial presentation, her fasting glucose was 18.1 mmol/L and her hemoglobin A1c was 13.4% (normal 4.5% to 6.5%). Results of the urinalysis were positive for glucose (> 55 mmol/L) and ketones (> 7.8 mmol/L). The family physician made a clinical diagnosis of type 1 DM and referred her to the local diabetes management centre. She was seen the same day at the diabetes centre and started on intensive insulin therapy, with multiple daily injections, after consultation with the endocrinologist. Upon presentation her weight was 63 kg with a calculated body mass index of 23.4 kg/m2. She had no family history of DM, and test results were negative for anti-islet cel Continue reading >>

Ketosis-prone Atypical Diabetes: Glucagon Is There, Too

Ketosis-prone Atypical Diabetes: Glucagon Is There, Too

Ketosis-Prone Atypical Diabetes: Glucagon Is There, Too Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, University of Lige, Lige, Belgium Corresponding author: Pierre Lefbvre, [email protected] . Author information Copyright and License information Disclaimer Copyright 2013 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details. See " - and -Cell Dysfunctions in Africans With Ketosis-Prone Atypical Diabetes During Near-Normoglycemic Remission " in volume 36 onpage118. As stated by Zimmet et al. ( 1 ) in the initial chapter of a classical textbook on diabetes, the major requirement for orderly epidemiologic, genetic, and clinical research on diabetes and glucose intolerance, and indeed for their clinical management, is an appropriate classification. Furthermore, a hallmark in the process of understanding the etiology of a disease and studying its natural history is the ability to identify and differentiate its various forms and place them into a rational etio-pathologic framework. In 1984, Ahrn and Corrigan ( 2 ) reported the existence of a subgroup of diabetic patients observed in Tanzania where the need for insulin replacement therapy fluctuates with time, waxes and wanes, and transient ketoacidosis develops. This subtype of diabetes is not unusual in African Americans and sub-Saharan Africans and currently recognized under the term of ketosis-prone atypical diabetes (KPD) (review in ref. 3 ). Classifying KPD in relation with the other more frequent forms of diabetes is not easy. At the onset, KPD often appears as type 1 diabetes with acute hyperglycemia and ketosis or ketoacidosis and the o Continue reading >>

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