Article Text

  1. D. Smiley,
  2. G. Umpierrez
  1. Emory University School of Medicine, Atlanta, GA


Many newly diagnosed African Americans with diabetic ketoacidosis (DKA) display clinical, metabolic, and immunological features of type 2 diabetes during follow-up. 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. This clinical presentation is common, affecting 20-50% of newly diagnosed black and Hispanic patients with DKA. This subtype of diabetes is referred to as diabetes type 1B, idiopathic type 1 diabetes, atypical diabetes, Flatbush diabetes, type 1.5 diabetes, and, more recently, ketosis-prone type 2 diabetes (KPDM). We reviewed current knowledge regarding the clinical presentation, metabolic, and immunologic features of subjects with this "atypical " 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 "ketosis-prone type 2 diabetes " and "atypical diabetes " were reviewed. In this analysis we included 484 cases (429 blacks, 39 Hispanics, 8 Asians, 8 Caucasians) from 7 series reported from America, Europe, Africa, and Asia. Clinical characteristic include a mean age of 40 6 3 years, male gender 67% 6 9, new-onset diabetes: 83%, % family history: 80 6 5, % positive antibodies: 7.1 6 7, % patients who attained remission: 59 6 15, A1C at presentation: 13.2 6 0.6%, and A1C at remission: 7.0 6 1.2%. 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 (islet cell and glutamic acid decarboxylase antibodies) and measurement of insulin secretion (basal or glucagon-stimulated C-peptide levels) may be useful in predicting near-normoglycemic remission. Our analysis indicates that what was once considered as "atypical diabetes " is a common clinical presentation among newly diagnosed black and Hispanic patients with DKA. This subtype of diabetes with phasic insulin dependence represents a subset of type 2 diabetes and confirms the wide spectrum of clinical presentation of type 2 diabetes.

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