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Patients with Ketosis-prone type 2 diabetes appear more insulin resistant than patients with non-ketotic type 2 diabetes at the time of acute destabilisation

Whyte, MB (2015) Patients with Ketosis-prone type 2 diabetes appear more insulin resistant than patients with non-ketotic type 2 diabetes at the time of acute destabilisation In: Diabetes UK Professional Conference 2015, 2015-03-11 - 2015-03-13, ExCeL London, UK.

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Abstract

Aims: Ketosis-prone Type 2 diabetes (KPDM) describes an unusual form of diabetes: the occurrence of ketosis but negative autoantibodies and the ability to manage without long-term insulin therapy. KPDM is considered primarily a result of acute beta cell failure. We reviewed insulin-dose requirements at hospital discharge as a surrogate measure of acute insulin resistance in newly diagnosed antibody-negative diabetes, in patients with and without significant ketonuria. Methods: Data were collected from patients admitted with ketone-positive symptomatic hyperglycaemia at an urban hospital. All cases were treatment-na€ıve on admission with glucose >12mmol/l and subsequently proved to be negative for GAD and ICA antibody. KPDM had admission pH ≤ 7.30, bicarbonate ≤15mmol/l and urinary ketones ≥80mg/dl. Ketosis-only (KO) had ketones ≥80mg/dl but pH >7.30. Type 2 diabetes had ketones ≤40mg/dl. Data are mean SEM. Results: Over 30 months, 9 KPDM, 19 KO and 10 Type 2 diabetes were studied. There was no difference in age between the KPDM, KO and Type 2 diabetes groups (37.8 4.0, 47.8 2.4, 43.0 3.5 years) and a similar distribution of ethnicity. The admission glucose and HbA1c were no different between groups (glucose 37.2 3.2, 32.0 3.2, 34.9 4.1mmol/l; HbA1c 133 10, 120 7, 114 10mmol/mol). Groups had comparable body weight (87.3 3.7, 92.4 7.3, 100.5 6.7kg). There was a trend to greater total daily dose of insulin at discharge in the KPDM group (72.9 3.2 units/day) than the KO (52.0 6.3 units/day) or Type 2 diabetes (49.4 5.1 units/day) groups, p=0.06. This was significant when normalised per kilogram of body weight (0.85 0.04, 0.56 0.06, 0.51 0.07 units/kg/ day; p=0.01). Conclusion: KPDM appears to exhibit greater insulin resistance than other forms of diabetes at acute presentation. Along with beta cell dysfunction, this may be the precipitant for metabolic destabilisation and ketosis.

Item Type: Conference or Workshop Item (Conference Poster)
Subjects : Nutrition
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine > Department of Nutritional Sciences
Authors :
AuthorsEmailORCID
Whyte, MBUNSPECIFIEDUNSPECIFIED
Date : 11 March 2015
Identification Number : https://doi.org/10.1111/dme.12668
Copyright Disclaimer : © 2015 The Authors. Diabetic Medicine © 2015 Diabetes UK
Depositing User : Symplectic Elements
Date Deposited : 19 Oct 2016 13:39
Last Modified : 19 Oct 2016 13:39
URI: http://epubs.surrey.ac.uk/id/eprint/812512

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