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Should diabetic ketosis without acidosis be included in ketosis-prone type 2 diabetes mellitus?

Authors

  • Xiao-Jing Xie,

    1. Department of Endocrinology, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, China
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    • These authors contributed equally to this work.

  • Yun Hu,

    1. Department of Endocrinology, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, China
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    • These authors contributed equally to this work.

  • Cheng Cheng,

    1. Department of Endocrinology, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, China
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  • Tian-Tian Feng,

    1. Department of Endocrinology, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, China
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  • Ke He,

    1. Department of Endocrinology, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, China
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  • Xiao-Ming Mao

    Corresponding author
    1. Department of Endocrinology, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, China
    • Correspondence to: Xiao-Ming Mao, Department of Endocrinology, Nanjing First Hospital Affiliated to Nanjing Medical University, 68 ChangLe St., Nanjing 210006, China.

      E-mail: maoxming@163.com

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Abstract

Background

The incidence of ketosis-prone type 2 diabetes is very low except for people of sub-Saharan African origin and African Americans. However, there also are some type 2 diabetes patients with diabetic ketosis without acidosis (DKWA). We question whether DKWA should be included as a subtype of ketosis-prone type 2 diabetes mellitus and compared the clinical characteristics of DKWA and diabetic ketoacidosis (DKA) patients.

Methods

The study population consisted of 594 consecutive unrelated Chinese inpatients with newly diagnosed type 2 diabetes. Demographic and clinical characteristics (age, gender, family history of diabetes, body mass index, blood pressure and plasma lipid parameters) were recorded. The patients were divided into ketosis-resistant diabetes (KRD), DKWA and DKA groups on the basis of urinary ketones, blood pH and bicarbonate levels. The blood glucose and c-peptide levels of the patients were also evaluated.

Results

The prevalence of KRD, DKWA and DKA were 78.33%, 19.72% and 1.95%, respectively, in the study population. The clinical characteristics of patients with DKWA group patients were similar to those with DKA, except that DKA patients had higher blood glucose and deteriorated β cell function.

Conclusions

Diabetic ketosis without acidosis and DKA patients share similar clinical characteristics; DKWA should be considered ketosis-prone type 2 diabetes. Therefore, the prevalence of ketosis-prone type 2 diabetes might be underestimated. Copyright © 2013 John Wiley & Sons, Ltd.

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