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Management of Diabetes in Developing Countries
Published in Emmanuel Opara, NUTRITION and DIABETES, 2005
Jean Claude Mbanya, Eugene Sobngwi
The initial presentation of ketosis-prone diabetes is usually acute with important symptoms, such as polyuria, polydipsia, and weight loss. The random blood glucose is very high, often above 30 mmol/l, ketone bodies are present in the urine, and there may be ketoacidosis with low pH and serum bicarbonates. Thus, the initial presentation requires insulin treatment with appropriate fluid and electrolyte management when necessary.
Islet autoantibody positivity in overweight and obese adults with type 2 diabetes
Published in Autoimmunity, 2018
Scott J. Pilla, Ashok Balasubramanyam, William C. Knowler, Mariana Lazo, David M. Nathan, Xavier Pi-Sunyer, Jeanne M. Clark, Nisa M. Maruthur
Among patients with undifferentiated diabetes or Ketosis Prone Diabetes, the presence of islet autoantibodies may help to improve classification of diabetes subtype and predict future beta cell dysfunction [14–16]. However, the clinical utility of islet autoantibody testing is less clear in patients with an established diagnosis of type 2 diabetes [9]. In the UKPDS 25 report, patients with islet autoantibodies were less likely to achieve glycemic control in response to an initial three-month trial of dietary change, suggesting this may be important in considering nonpharmacologic diabetes therapy [2,17]. As lifestyle change, including weight loss for overweight and obese patients, is a component of the initial therapy for all patients with type 2 diabetes [18], determining whether islet autoantibody status affects the results of diabetes lifestyle interventions may have important consequences for diabetes care. In addition, the effects of islet autoantibody status on longitudinal changes in weight and adiposity among patients with type 2 diabetes are not known.
Acute pancreatitis secondary to hypertriglyceridemia precipitated by diabetic ketoacidosis in a previously undiagnosed ketosis-prone patient with diabetes mellitus
Published in Baylor University Medical Center Proceedings, 2018
Vignesh Ramachandran, Diana M. Vila, John M. Cochran, Andrew C. Caruso, Rajeev Balchandani
Ketosis-prone diabetes is a ubiquitous, heterogeneous syndrome denoted by patients who do not encompass the typical phenotype of autoimmune type 1 DM but may nevertheless present with DKA or unprovoked ketosis.9 The Aβ classification of Balasubramanyam et al is a novel approach to considering ketosis-prone diabetes.10 Under this system, autoantibodies to glutamic acid decarboxylase (GAD-65) or tyrosine phosphatase-like protein IA-2 (IA-2) assess autoimmune destruction of islet cells and C-peptide levels determine the functionality of the pancreatic β cells. One longitudinal study of patients under the Aβ classification demonstrated that particular groups were more ketosis prone than others (Table 3).11 However, the mechanisms that trigger these patients to develop DKA are poorly defined.9 Our patient, a 33-year-old obese man, does not fit the traditional mold of a type 1 DM patient. His workup revealed results consistent with A-β+ DM (autoantibodies were below the 99th percentile with normal pancreatic beta cell functioning) with a 54% chance of being a ketosis-prone diabetic (Table 3). This could account for his presentation.
Characteristics of subjects with diabetes mellitus diagnosed before 35 years of age presenting to a tertiary diabetes clinic in Durban, South Africa, from 2003 to 2016
Published in Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2018
Prevendri Govender, Khaled Elmezughi, Tonya Esterhuizen, Imran Paruk, Fraser James Pirie, Ayesha Ahmed Motala
Type 1 diabetes was defined if ≥ 1 of the following was present: presentation with DKA; positive anti-GAD or IA2 antibodies; fasting c-peptide (measured within the first year) < 0.75 ng/ml or glucagon-stimulated c-peptide < 1.8 ng/ml and absolute insulin dependence.15 Type 2 diabetes was defined as insidious presentation, absence of anti-GAD and anti-IA2 antibodies, insulin independence, clinical markers of insulin resistance and c-peptide levels above the T1D threshold.15 Ketosis-prone diabetes was defined in persons who presented with DKA or had an episode of DKA, absence of anti-GAD and anti-IA2 antibodies and initial insulin dependence with possible subsequent transition to oral therapy.13,16