Diabetic Ketoacidosis: A Common Debut of Diabetes Among African Americans With Type 2 Diabetes

Abstract

Objective More than half of African Americans (AA) with a new diagnosis of diabetic ketoacidosis have clinical and metabolic features of type 2 diabetes during follow-up. This particular presentation of diabetes has been termed as ketosis-prone type 2 diabetes (KPDM) or atypical diabetes. Methods We review the epidemiology, diagnosis, pathophysiology, and acute and long-term management of AA with KPDM and compare these similarities to patients with type 2 diabetes. Results In contrast to the long-term insulin requirement of auto-immune type 1 diabetes, patients with KPDM are able to discontinue insulin after a few months of therapy and maintain acceptable glycemic control for many years on either diet or oral agents. Patients with KPDM have significant impairment of both insulin secretion and insulin action at presentation; however, at the time of near-normoglycemia remission, insulin secretion and action improve to levels similar to hyperglycemic patients with ketosis-resistant type 2 diabetes. In the long term, however, patients with KPDM have a decline in β-cell function similar to patients with type 2 diabetes. Recent studies indicate that treatment with metformin and dipeptidyl peptidase-4 inhibitors can prolong the period of near-normoglycemia remission for several years compared to placebo therapy. Conclusion KPDM is a unique but common presentation of newly diagnosed African Americans with type 2 diabetes.

Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients

“…These include the rising prevalence of diabetes, as well as psychosocial, cultural, and economic factors that often limit access to insulin and outpatient medical care 131617. Diabetic ketoacidosis causes an estimated medical expenditure of $2.4bn (£1.9bn; €2.1bn) per year in the US 10.…”

Advances in type 2 diabetes therapy: a focus on cardiovascular and renal outcomes

“…The initial outcome trials and a meta‐analysis did not find an excess risk of diabetic ketoacidosis among people with type 2 diabetes who were receiving SGLT2 inhibitor therapy. Furthermore, diabetic ketoacidosis may occur in people with type 2 diabetes who are not taking SGLT2 inhibitors . However, there are numerous post‐marketing reports of diabetic ketoacidosis associated with SGLT2 inhibitor use and many clinicians have encountered it in their clinical practice.…”

“…Furthermore, diabetic ketoacidosis may occur in people with type 2 diabetes who are not taking SGLT2 inhibitors. 20 However, there are numerous post-marketing reports of diabetic ketoacidosis associated with SGLT2 inhibitor use and many clinicians have encountered it in their clinical practice. In the most recent DECLARE-TIMI 58 trial, diabetic ketoacidosis was uncommon, but occurred at a higher rate in the dapagliflozin group than in the placebo group (0.3% v 0.1%; P = 0.02).…”

Increasing incidence of type 2 diabetes in New Zealand children <15 years of age in a regional‐based diabetes service, Auckland, New Zealand

“…Notably, in this study no cases presented with diabetic ketoacidosis or non-ketotic hyperosmolar coma, in contrast with rising rates of ketosis in some high-risk populations. 2,17,28,29 For example, the Paediatric Diabetes Consortium in the USA reported that 11% presented with diabetic ketoacidosis and 2% with hyperglycaemic hyperosmolar state. 17 This suggests that very late presentation is being avoided in Auckland; possibly because of wide spread access to low cost or free care.…”