The Clinical Characteristics Of Ketosis-Prone Type 2diabetes

Objective In recent years, there have been reported that ketosispronediabetes(KPD), not equal to type 1 diabetes, included type 1 diabetes with evidence of autoimmune and ketosis-prone type 2 diabetes. The pathogenesis of the latter might be the increased the sensitivity of islet cells to oxidative stress induced by glucose and lipid toxicity due to genetic variation, resulting in severe damage to islet function and insulin resistance, then inducing diabetic ketoacidosis. Some of these patients require long-term insulin therapy forβ cell dysfanction, but some of the other patients, ketosis or ketoacidosis only occurred at specific stages and most of islet function could recover after normal blood glucose was reached by treatment with insulin, similar to patients with typical type 2 diabetes. In this study, we observed the clinical characteristics of the patients with diabetic ketosis as the first symptom; classified these patients; and compared them with patients with typical type 2 diabetes on their clinical characteristics at the disease onset.Methods 262 patients diagnosed with diabetes(according to the 1999 WHO diagnostic criteria for diabetes) and admitted in our department from 2012 to 2014 were included in this study. 171 patients were male and 91 patients were female; the ages of all patients ranged from 21 to 72. All patients met the following criteria: 1. diagnosed as diabetes for the first time, and no drug was applied before diagnosis; 2. without cancer, fever, surgery,trauma, and chronic hunger before admission. 3. no drug which had impact on glucose metabolism was used, such as glucocorticoid; 4. without gestational diabetes and secondary diabetes. 5. Patients were divided into two groups, ketosis-prone type 2 diabetes group and non-ketosis type 2 diabetes group. Ketosis-prone diabetes is defined as urine ketone ++ or above, or blood ketone ≥1.0mmol / L. Fasting venous blood samples of all patients were taken in the early morning of the next day after admission, and liver function,kidney function, blood glucose, triglycerides, total cholesterol, glycosylated hemoglobin, fasting C-peptide, GAD antibody and ICA antibody were determined for each patient.24-hour urine specimen of each patient was collected to determine the 24-hour urine microalbumin excretion rate.Results: 1.The proportion of male patients in ketosis-prone type 2 diabetes group was significantly higher than that in non-ketosis type 2 diabetes group(P <0.01). 2. The ketosis-prone type 2 diabetes group was comparative younger than that of in non-ketosis type 2 diabetes group.3. The disease duration of ketosis-prone type 2 diabetes group was shorter than non-ketosis type 2 diabetes group 4.The fasting C-peptide levels in ketosis-prone type 2 diabetes group was significantly lower than those in non-ketosis type2 diabetes group(P <0.05). 5. The decrease of body mass and the glycosylated hemoglobin in ketosis-prone type 2 diabetes group was significantly higher than those in non-ketosis type 2 diabetes group(P <0.05).Conclusion: The age, proportion of males, fasting C-peptide, glycosylated hemoglobin and decrease of body mass were significantly different between the two groups.