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Ketosis Prone Diabetes Type 1

Update In Pulmonary Medicine | Annals Of Internal Medicine | American College Of Physicians

Update In Pulmonary Medicine | Annals Of Internal Medicine | American College Of Physicians

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 -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 -cell dysfunction in ketosis-prone type 2 diabetes are not known; however, preliminary evidence suggests an increased susceptibility to glucose desensitization. Continue reading >>

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 >>

Ketosis-prone Diabetes Mellitus | Definition Of Ketosis-prone Diabetes Mellitus By Medical Dictionary

Ketosis-prone Diabetes Mellitus | Definition Of Ketosis-prone Diabetes Mellitus By Medical Dictionary

Ketosis-prone diabetes mellitus | definition of ketosis-prone diabetes mellitus by Medical dictionary Also found in: Dictionary , Thesaurus , Encyclopedia . a general term referring to any of various disorders characterized by excessive urination (polyuria); when used alone, the term refers to diabetes mellitus . (See Atlas 4, Part D). brittle diabetes diabetes that is difficult to control, characterized by unexplained oscillation between hypoglycemia and diabetic ketoacidosis . (This term was formerly much used, but it is not a classification used by the World Health Organization or the American Diabetes Association.) central diabetes insipidus a metabolic disorder due to injury of the neurohypophyseal system, which results in a deficient quantity of antidiuretic hormone (ADH or vasopressin) being released or produced, resulting in failure of tubular reabsorption of water in the kidney. As a consequence, there is the passage of a large amount of urine having a low specific gravity, and great thirst; it is often attended by voracious appetite, loss of strength, and emaciation. Diabetes insipidus may be acquired through infection, neoplasm, trauma, or radiation injuries to the posterior lobe of the pituitary gland or it may be inherited or idiopathic. Treatment of pituitary diabetes insipidus consists of administration of vasopressin. A synthetic analogue of vasopressin (DDAVP) can be administered as a nasal spray, providing antidiuretic activity for 8 to 20 hours, and is currently the drug of choice. Patient care includes instruction in self-administration of the drug, its expected action, symptoms that indicate a need to adjust the dosage, and the importance of follow-up visits. Patients with this condition should wear some form of medical identification at all times. 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 >>

Hba1c As A Screening Tool For Ketosis In Patients With Type 2 Diabetes Mellitus

Hba1c As A Screening Tool For Ketosis In Patients With Type 2 Diabetes Mellitus

HbA1c as a Screening tool for Ketosis in Patients with Type 2 Diabetes Mellitus Scientific Reports volume 6, Articlenumber:39687 (2016) Ketosis in patients with type 2 diabetes mellitus (T2DM) is overlooked due to atypical symptoms. The objective of this study is to evaluate the value of hemoglobin A1c (HbA1c) as a screening tool for ketosis in T2DM patients. This retrospective study consisted of 253 T2DM patients with ketosis at Shanghai 10th Peoples Hospital during a period from January 1, 2011 to June 30, 2015. A control group consisted of 221 T2DM patients without ketosis randomly selected from inpatients during the same period. Receiver operating characteristic curve (ROC) analysis was used to examine the sensitivity and specificity of HbA1c as an indicator for ketosis. Higher HbA1c levels were correlated with ketosis. In patients with newly diagnosed T2DM, the area under the curve (AUC) was 0.832, with 95% confidence interval (CI) 0.7540.911. The optimal threshold was 10.1% (87 mmol/mol). In patients with previously diagnosed T2DM, the AUC was 0.811 (95% CI: 0.7670.856), with an optimal threshold of 8.6% (70 mmol/mol). HbA1c is a potential screening tool for ketosis in patients with T2DM. Ketosis is much more likely with HbA1c values at 10.1% in patients with newly diagnosed T2DM and HbA1c values at 8.6% in patients with previously diagnosed T2DM. Ketosis-prone type 2 diabetes is defined as the A-+ ketosis-prone diabetes (KPD) subgroup 1 . This subgroup is a major factor driving the increasing prevalence of KPD 2 , 3 , 4 , 5 , 6 , 7 . The term ketosis-prone type 2 diabetes (T2DM) is often used to describe the A-+ patients who present with new onset diabetes, unprovoked diabetic ketoacidosis (DKA) 8 , 9 and acidosis 10 , 11 , 12 . As a result, the prevalence of ke Continue reading >>

Ketosis Prone Diabetes- A Clinical View | 72574

Ketosis Prone Diabetes- A Clinical View | 72574

Introduction: Ketosis Prone Type 2 Diabetes (KPD) is also known as Flatbush Diabetes, due to the cluster of patients identifiedin the Flatbush section of Brooklyn, NY with new onset of type 2 diabetes accompanied by Diabetic Ketoacidosis (DKA) as the firstmanifestation. These patients have an absence (A-) or presence (A+) of islet cell autoantibodies and quantitive differences in beta cellfunction. The A-B+ is the most frequent manifestation. These patients parameters resemble type 2 diabetes, in that it usually occursin the adult population, they are overweight or obese, a strong family history of type 2 diabetes, do not have islet cell autoantibodies,and have a plentiful reserve of pancreatic beta cells, which have been measured after the index case of KPD. They may also havephysical signs such as acanthosis nigricans and abdominal straie. They have an unprovoked episode of diabetic ketoacidosis (DKA),and may have blurred vision, nausea, vomiting or abdominal pain, which bring them to the emergency department. They may alsohave polyuria resulting in dehydration secondary to blood glucose numbers far in excess of type 1 diabetics. Treatment is the same asfor any DKA patient, and they usually are treated with a basal/bolus regimen, along with metformin, which is increased as tolerated.They generally have rapid beta cell recovery and many eventually stay on metformin as a preventative measure; some require onlylifestyle modifications. This holiday period may last from months to years. The most common subtype of KPD is A- B+ (54%).Case: 33-year-old African American woman, With a BMI of 42 mg/kg m2, G 6, P 2. Her children are aged 15 and 5. She had littleprenatal care with her first child, and at time of labor she was found to have gestational diabetes (GDM). She was star 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 >>

Ketosis-prone Diabetes

Ketosis-prone Diabetes

Ketosis-prone diabetes or KPD is an intermediate form of diabetes that has some characteristics of type 1 and some of type 2 diabetes. However, it is distinct from latent autoimmune diabetes , a form of type 1 sometimes referred to as type 1.5. [1] KPD is readily diagnosible because it presents a single characteristic, ketoacidosis, which if present, confirms it as ketosis-prone diabetes. [2] KPD comes in four forms depending upon the presence or absence of -cell autoantibodies (A+ or A) and -cell functional reserve (+ or ). [3] ^ There is clearly a spectrum of clinical phenotypes among patients with islet autoantibodies who do not present with ketosis, including those termed latent autoimmune diabetes in adults (LADA) (30), type 1.5 diabetes (31,32,33), and slowly progressing type 1 diabetes (34). A similar spectrum exists in KPD that includes the very different phenotypes of A+ and A++ KPD. A+ KPD is synonymous with classic, early onset autoimmune type 1 diabetes; A++ KPD may overlap with LADA. However, there are differences between LADA, as recently defined by the Immunology of Diabetes Society, and A++ KPD patients; most importantly, the definition of LADA excludes patients who require insulin within the first 6 months after diagnosis, whereas the majority (90%) of A++ KPD patients present with DKA as the first manifestation of diabetes and therefore require insulin at the start. 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 >>

Syndromes Of Ketosis-prone Diabetes Mellitus

Syndromes Of Ketosis-prone Diabetes Mellitus

Syndromes of Ketosis-Prone Diabetes Mellitus Ashok Balasubramanyam , Ramaswami Nalini , Christiane S. Hampe , and Mario Maldonado Translational Metabolism Unit (A.B., R.N., M.M.), Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, Texas 77030; Endocrine Service (A.B., R.N.), Ben Taub General Hospital, Houston, Texas 77030; Robert H. Williams Laboratory (C.S.H.), University of Washington, Seattle, Washington 98195; and Novartis, Inc. (M.M.), CH-4002 Basel, Switzerland Address all correspondence and requests for reprints to: Ashok Balasubramanyam, M.D., Translational Metabolism Unit, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Room 700B, One Baylor Plaza, Houston, Texas 77030. E-mail: [email protected] Received 2007 Aug 13; Accepted 2008 Jan 9. Copyright 2008 by The Endocrine Society This article has been cited by other articles in PMC. Ketosis-prone diabetes (KPD) is a widespread, emerging, heterogeneous syndrome characterized by patients who present with diabetic ketoacidosis or unprovoked ketosis but do not necessarily have the typical phenotype of autoimmune type 1 diabetes. Multiple, severe forms of -cell dysfunction appear to underlie the pathophysiology of KPD. Until recently, the syndrome has lacked an accurate, clinically relevant and etiologically useful classification scheme. We have utilized a large, longitudinally followed, heterogeneous, multiethnic cohort of KPD patients to identify four clinically and pathophysiologically distinct subgroups that are separable by the presence or absence of -cell autoimmunity and the presence or absence of -cell functional reserve. The resulting A classification system of KPD has proven to be highly accurate and predictive of such clinically importan 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 >>

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 >>

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

Ketosis-prone Type 2 Diabetes

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. Since the mid-1990s, the number of patients who presented with DKA but did not require long-term insulin therapy has increased. Many such patients had conditions that resembled traditionally defined type 2 diabetes, in that they were obese and often had a family history of diabetes. Subsequent to these observations, new ways to classify diabetes were devised. The system of classification that most accurately predicts the need for insulin treatment 12 months after presentation with DKA is known as the A system. This system classifies diabetics into 4 groups as follows: A+- - Autoantibodies present, cell function absent A++ - Autoantibodies present, cell function present A-- - Autoantibodies absent, cell function absent A-+ - Autoantibodies absent, cell function present The commonest ketosis-prone diabetes (KPD) subgroup in a longitudinal study was A-+ (54%), followed by A-- (20%) A+- (18%) and A++ (8%). [ 1 ] As noted above, in the A-+ subgroup of patients with KPD cell antibodies are absent and cell function is pres 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 >>

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