Clinical Heterogeneity and Autoimmunity Profiles of Patients with Diabetic Ketosis or Ketoacidosis_West China Medical Journal

Authors：

 TanHuiwen ¹ , ZhouYunxia ¹ ,  YuYerong ¹ , WangChun ¹ , ZhangXiangxun ²

1. Department of Endocrinology;West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Laboratory of Endocrinology and Metabolism;West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

YuYerong, Email: yerongyu@scu.edu.cn

Keywords：

Diabetic ketosis; Diabetic ketoacidosis; Contributing factor; Auto-immunologic profile; Clinical characteristics

DOI：

10.7507/1002-0179.201600274

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Objective To investigate the clinical heterogeneity and auto-immunologic state in patients with diabetic ketosis (DK) or diabetic ketoacidosis (DKA). Methods Diabetic patients who presented with DK/DKA were recruited from West China Hospital of Sichuan University from January 1, 2000, to December 31, 2008. We analyzed the clinical classification, biochemical profiles, and auto-immunologic state of the patients. Results Among them, 257 (15.0%) patients had type 1 diabetes, while 883 (51.6%) with type 2 diabetes, and 515 (30.1%) could be typed as "atypical diabetes" or "untying diabetes". The average age of hospitalized patients with type 1 diabetes was (31.1±13.5) years, which was significantly lower than that of the type 2 diabetes patients [(58.1±13.2) years] (P＜0.001). The most common contributing factor for DK/DKA was infection, followed by noncompliance with therapy. Glutamic acid decarboxylase antibody positive rate was 4.37% in patients with "atypical diabetes", which was similar with type 2 diabetes group (2.69%, P=0.79), but lower than that of the patients with type 1 diabetes (13.79%, P＜0.001). Conclusions We conclude that DK or DKA can occur not only in type 1 diabetic patients but also in patients with type 2 diabetes under infection or stress condition. DK/DKA patients have a high clinical heterogeneity. The auto-immunologic state and β-cell function have significant implications for the diagnosis and classification of diabetes.

Citation： TanHuiwen, ZhouYunxia, YuYerong, WangChun, ZhangXiangxun. Clinical Heterogeneity and Autoimmunity Profiles of Patients with Diabetic Ketosis or Ketoacidosis. West China Medical Journal, 2016, 31(6): 1019-1022. doi: 10.7507/1002-0179.201600274 Copy

1.	朱宏达, 陈名道. 酮症起病的糖尿病[J]. 中华内分泌代谢杂志, 2004, 20(4): 378-380.
2.	Umpierrez GE, Casals MM, Gebhart SP, et al. Diabetic ketoacidosis in obese African-Americans[J]. Diabetes, 1995, 44(7): 790-795.
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5.	Wang C, Tan H, Yu H, et al. Impairment of insulin action in nonobese, normal-glucose tolerant, first-degree relatives of Chinese type 2 diabetic patients[J]. Diabetes Res Clin Pract, 2011, 91(1): 67-71.
6.	谭惠文, 王椿, 余叶蓉, 等. 酮症倾向糖尿病患者临床特征和异质性研究[J]. 中华内分泌代谢杂志, 2013, 29(12): 1026-1030.
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10.	Gosmanov AR, Smiley D, Robalino G, et al. Effects of intravenous glucose load on insulin secretion in patients with ketosis-prone diabetes during near-normoglycemia remission[J]. Diabetes Care, 2010, 33(4): 854-860.
11.	Patel SG, Hsu JW, Jahoor F, et al. Pathogenesis of a−β+ketosis-prone diabetes sewfr4[J]. Diabetes, 2013, 62(3): 912-922.
12.	Thawabi M, Studyvin S. Euglycemic diabetic ketoacidosis, a misleading presentation of diabetic ketoacidosis[J]. N Am J Med Sci, 2015, 7(6): 291-294.
13.	Wang X, Tan H. Male predominance in ketosis-prone diabetes mellitus[J]. Biomed Rep, 2015, 3(4): 439-442.
14.	Ohara N, Kaneko M, Nishibori T, et al. Fulminant type 1 diabetes mellitus associated with coxsackie virus type a2 infection: a case report and literature review[J]. Intern Med, 2016, 55(6): 643-646.
15.	Gosmanov AR, Gosmanov NR. Advancing clinical care for the patients with ketosis-prone diabetes: from knowledge to action[J]. J Diabetes Complications, 2015, 29(7): 853-854.
16.	Peeters E, van Ijperen WJ, Robertson L, et al. Analysis of the safety and efficacy of diabetic ketoacidosis management in a Community General Hospital, 2001-2010: a descriptive study[J]. Scott Med J, 2015, 60(3): 121-125.
17.	Rasouli N, Elbein SC. Improved glycemic control in subjects with atypical diabetes results from restored insulin secretion, but not improved insulin sensitivity[J]. J Clin Endocrinol Metab, 2004, 89(12): 6331-6335.
18.	Karges B, Rosenbauer J, Holterhus P, et al. Hospital admission for diabetic ketoacidosis or severe hypoglycemia in 31 330 young patients with type 1 diabetes[J]. Eur J Endocrinol, 2015, 173(3): 341-350.
19.	Hine J, Paterson H, Abrol E, et al. SGLT inhibition and euglycaemic diabetic ketoacidosis[J]. Lancet Diabetes Endocrinol, 2015, 3(7): 503-504.
20.	Gaba R, Gambhire D, Uy N, et al. Factors associated with early relapse to insulin dependence in unprovoked A-β+ ketosis-prone diabetes[J]. J Diabetes Complications, 2015, 29(7): 918-922.

1. 朱宏达, 陈名道. 酮症起病的糖尿病[J]. 中华内分泌代谢杂志, 2004, 20(4): 378-380.
2. Umpierrez GE, Casals MM, Gebhart SP, et al. Diabetic ketoacidosis in obese African-Americans[J]. Diabetes, 1995, 44(7): 790-795.
3. Nyenwe EA, Kitabchi AE. The evolution of diabetic ketoacidosis: an update of its etiology, pathogenesis and management[J]. Metabolism, 2016, 65(4): 507-521.
4. Concha LL, Durruty AP, García de Los Ríos AM. Ketosis prone type 2 diabetes (KPD)[J]. Rev Med Chil, 2015, 143(9): 1215-1218.
5. Wang C, Tan H, Yu H, et al. Impairment of insulin action in nonobese, normal-glucose tolerant, first-degree relatives of Chinese type 2 diabetic patients[J]. Diabetes Res Clin Pract, 2011, 91(1): 67-71.
6. 谭惠文, 王椿, 余叶蓉, 等. 酮症倾向糖尿病患者临床特征和异质性研究[J]. 中华内分泌代谢杂志, 2013, 29(12): 1026-1030.
7. Huang CY, Chen WL. Diabetic ketoacidosis as the initial presentation of hyperthyroidism[J]. Am J Emerg Med, 2015, 33(10): 1540.e1-1540.e2.
8. Chen HF, Wang CY, Lee HY, et al. Short-term case fatality rate and associated factors among inpatients with diabetic ketoacidosis and hyperglycemic hyperosmolar state: a hospital-based analysis over a 15-year period[J]. Intern Med, 2010, 49(8): 729-737.
9. Mauvais-Jarvis F, Sobngwi E, Porcher R, et al. Ketosis-prone type 2 diabetes in patients of sub-Saharan African origin: clinical pathophysiology and natural history of beta-cell dysfunction and insulin resistance[J]. Diabetes, 2004, 53(3): 645-653.
10. Gosmanov AR, Smiley D, Robalino G, et al. Effects of intravenous glucose load on insulin secretion in patients with ketosis-prone diabetes during near-normoglycemia remission[J]. Diabetes Care, 2010, 33(4): 854-860.
11. Patel SG, Hsu JW, Jahoor F, et al. Pathogenesis of a−β+ketosis-prone diabetes sewfr4[J]. Diabetes, 2013, 62(3): 912-922.
12. Thawabi M, Studyvin S. Euglycemic diabetic ketoacidosis, a misleading presentation of diabetic ketoacidosis[J]. N Am J Med Sci, 2015, 7(6): 291-294.
13. Wang X, Tan H. Male predominance in ketosis-prone diabetes mellitus[J]. Biomed Rep, 2015, 3(4): 439-442.
14. Ohara N, Kaneko M, Nishibori T, et al. Fulminant type 1 diabetes mellitus associated with coxsackie virus type a2 infection: a case report and literature review[J]. Intern Med, 2016, 55(6): 643-646.
15. Gosmanov AR, Gosmanov NR. Advancing clinical care for the patients with ketosis-prone diabetes: from knowledge to action[J]. J Diabetes Complications, 2015, 29(7): 853-854.
16. Peeters E, van Ijperen WJ, Robertson L, et al. Analysis of the safety and efficacy of diabetic ketoacidosis management in a Community General Hospital, 2001-2010: a descriptive study[J]. Scott Med J, 2015, 60(3): 121-125.
17. Rasouli N, Elbein SC. Improved glycemic control in subjects with atypical diabetes results from restored insulin secretion, but not improved insulin sensitivity[J]. J Clin Endocrinol Metab, 2004, 89(12): 6331-6335.
18. Karges B, Rosenbauer J, Holterhus P, et al. Hospital admission for diabetic ketoacidosis or severe hypoglycemia in 31 330 young patients with type 1 diabetes[J]. Eur J Endocrinol, 2015, 173(3): 341-350.
19. Hine J, Paterson H, Abrol E, et al. SGLT inhibition and euglycaemic diabetic ketoacidosis[J]. Lancet Diabetes Endocrinol, 2015, 3(7): 503-504.
20. Gaba R, Gambhire D, Uy N, et al. Factors associated with early relapse to insulin dependence in unprovoked A-β+ ketosis-prone diabetes[J]. J Diabetes Complications, 2015, 29(7): 918-922.

West China Medical Journal

Clinical Heterogeneity and Autoimmunity Profiles of Patients with Diabetic Ketosis or Ketoacidosis

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