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DIABETIC KETOACIDOSIS: A COMMON DEBUT OF DIABETES AMONG AFRICAN AMERICANS WITH TYPE 2 DIABETES.
Endocr Pract. 2017 May 23;:
Authors: Vellanki P, Umpierrez GE
Abstract
OBJECTIVE: More than half of African Americans (AA) with a new diagnosis of diabetic ketoacidosis have clinical and metabolic features of type 2 diabetes during follow-up. This particular presentation of diabetes has been termed as ketosis-prone type 2 diabetes (KPDM) or atypical diabetes.
METHODS: We review the epidemiology, diagnosis, pathophysiology and acute and long-term management of AA with KPDM and compare these similarities to patients with type 2 diabetes.
RESULTS: In contrast to the long-term insulin requirement of autoimmune type 1 diabetes, patients with KPDM are able to discontinue insulin after a few months of therapy and maintain acceptable glycemic control for many years on either diet or oral agents. Patients with KPDM have significant impairment of both insulin secretion and insulin action at presentation; however, at the time of near-normoglycemia remission, insulin secretion and action improve to levels similar to hyperglycemic patients with ketosis-resistant type 2 diabetes. At long-term; however, patients with KPDM have a decline in beta-cell function similar to patients with type 2 diabetes. Recent studies indicate that treatment with metformin and DPP4-inhibitors can prolong the period of near-normoglycemia remission for several years compared to placebo therapy.
CONCLUSION: KPDM is a unique but common presentation of newly diagnosed African Americans with type 2 diabetes.
PMID: 28534682 [PubMed - as supplied by publisher]