Article    Table of Contents                    Full Text of this article    PDF of this article (PDFs free after 6 months)    Figures/Tables List    CME course  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Umpierrez, G. E.    Kitabchi, A. E.    Related Articles in PubMed    PubMed Citation    PubMed

REVIEW

Narrative Review: Ketosis-Prone Type 2 Diabetes Mellitus

Guillermo E. Umpierrez, MD; Dawn Smiley, MD; and Abbas E. Kitabchi, PhD, MD

7 March 2006 | Volume 144 Issue 5 | Pages 350-357

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

Author and Article Information

From Emory University School of Medicine, Atlanta, Georgia, and University of Tennessee Health Science Center, Memphis, Tennessee.

Grant Support: In part by research grants from the American Diabetes Association (7-03-CR-35) (Dr. Umpierrez) and National Institutes of Health (R03 DK073190-01 and MO1-RR00039 [Dr. Umpierrez] and RR00211 [Drs. Kitabchi and Umpierrez]).

Potential Financial Conflicts of Interest: Grants received: A.E. Kitabchi (Lilly, Novo, Takeda, Aventis, Abbott).

Requests for Single Reprints: Guillermo E. Umpierrez, MD, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, Atlanta, GA 30303; e-mail, geumpie{at}emory.edu.

Current Author Addresses: Drs. Umpierrez and Smiley: Emory University School of Medicine, 49 Jesse Hill Jr. Drive, Atlanta, GA 30303.

Dr. Kitabchi: University of Tennessee Health Science Center, Room 334D, 956 Court Avenue, Memphis, TN 38163.

This article has been cited by other articles:

				E. Sobngwi, S. P. Choukem, F. Agbalika, B. Blondeau, L.-S. Fetita, C. Lebbe, D. Thiam, P. Cattan, J. Larghero, F. Foufelle, et al. Ketosis-Prone Type 2 Diabetes Mellitus and Human Herpesvirus 8 Infection in Sub-Saharan Africans JAMA, June 18, 2008; 299(23): 2770 - 2776. [Abstract] [Full Text] [PDF]

				R. Nalini, L. K. Gaur, M. Maldonado, C. S. Hampe, L. Rodriguez, G. Garza, A. Lernmark, and A. Balasubramanyam HLA Class II Alleles Specify Phenotypes of Ketosis-Prone Diabetes Diabetes Care, June 1, 2008; 31(6): 1195 - 1200. [Abstract] [Full Text] [PDF]

				A. Balasubramanyam, R. Nalini, C. S. Hampe, and M. Maldonado Syndromes of Ketosis-Prone Diabetes Mellitus Endocr. Rev., May 1, 2008; 29(3): 292 - 302. [Abstract] [Full Text] [PDF]

				A. E. Kitabchi, G. E. Umpierrez, J. N. Fisher, M. B. Murphy, and F. B. Stentz Thirty Years of Personal Experience in Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State J. Clin. Endocrinol. Metab., May 1, 2008; 93(5): 1541 - 1552. [Abstract] [Full Text] [PDF]

				C. S. Hampe, R. Nalini, M. R. Maldonado, T. R. Hall, G. Garza, D. Iyer, and A. Balasubramanyam Association of Amino-Terminal-Specific Antiglutamate Decarboxylase (GAD65) Autoantibodies with {beta}-Cell Functional Reserve and a Milder Clinical Phenotype in Patients with GAD65 Antibodies and Ketosis-Prone Diabetes Mellitus J. Clin. Endocrinol. Metab., February 1, 2007; 92(2): 462 - 467. [Abstract] [Full Text] [PDF]

				A. Balasubramanyam, G. Garza, L. Rodriguez, C. S. Hampe, L. Gaur, A. Lernmark, and M. R. Maldonado Accuracy and Predictive Value of Classification Schemes for Ketosis-Prone Diabetes Diabetes Care, December 1, 2006; 29(12): 2575 - 2579. [Abstract] [Full Text] [PDF]

				A. E. Kitabchi, G. E. Umpierrez, M. B. Murphy, and R. A. Kreisberg Hyperglycemic Crises in Adult Patients With Diabetes: A consensus statement from the American Diabetes Association Diabetes Care, December 1, 2006; 29(12): 2739 - 2748. [Full Text] [PDF]

				G. E. Umpierrez Ketosis-Prone Type 2 Diabetes: Time to revise the classification of diabetes Diabetes Care, December 1, 2006; 29(12): 2755 - 2757. [Full Text] [PDF]

				A. A. Ginde, A. J. Pelletier, and C. A. Camargo Jr. National study of u.s. Emergency department visits with diabetic ketoacidosis, 1993-2003. Diabetes Care, September 1, 2006; 29(9): 2117 - 2119. [Full Text] [PDF]