Arginine Metabolism Is Altered in Adults with A-β + Ketosis-Prone Diabetes

Mulukutla, Surya N.; Hsu, Jean W.; Gaba, Ruchi; Bohren, Kurt M.; Guthikonda, Anu; Iyer, Dinakar; Ajami, Nadim J.; Petrosino, Joseph F.; Hampe, Christiane S.; Ram, Nalini; Jahoor, Farook; Balasubramanyam, Ashok

doi:10.1093/jn/nxx032

Cited by 15 publications

(10 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[20,21] Screening and treatment for microvascular and macrovascular complications of diabetes should be advised according to American Diabetes Association (ADA) recommendation and long term management guidelines. [22] In summary, the description is of a case of ketosis prone diabetes in an obese young Chinese teenager, who displayed uncommon clinic presentation and findings typical of both type 1 and type 2 diabetes. However, after initial insulinization near-normoglycaemic control and restoration of normotriglycemia rapidly lead to improvement in beta-cell function.…”

Section: Discussionmentioning

confidence: 99%

Ketosis-prone diabetes mellitus in an obese adolescent

Tan

Wang

2019

Medicine

View full text Add to dashboard Cite

Rationale: In recent years, there are more new insights into the clinical susceptibility, pathophysiological mechanism, and progression of classification and treatment of ketosis-prone diabetes mellitus (KPDM), which was once described as Idiopathic Type 1 Diabetes, Type 1B Diabetes or Flatbush Diabetes. ketosis-prone diabetes mellitus is still a heterogeneous syndrome reported in African-American or western Sub-Sahara-African, Hispanic descendant, and recently in Asian. Patient concerns: An obese 17-year-old student was admitted to a tertiary referral hospital (teaching hospital), presenting with thirst, polyuria fatigue, and a 9 kg weight loss in the preceding two weeks. Diagnoses: Physical examination showed body mass index (BMI) was 32.77 kg/m 2 , arterial blood gas revealed a pH of 7.31. Serum glucose was 27.8 mmol/L with strong positive uric ketones (++++). Hemoglobin A1c (HbA1c) was 13.6%. The glucose disposal ratio (GDR) during the steady-state of euglycemic clamp test was 5.62 mg/kg/min and M value was 2.87 mg/kg/min during hyperglycemic clamp test. Those findings were sufficient to establish a diagnosis of ketosis-prone diabetes mellitus. Interventions: This obese patient with KPDM received intensive insulin therapy and fluids infusion, and during the remainder of hospitalization his insulin requirement was approximately 1.5 U per kilogram of body weight per day. Blood glucose monitoring was rigorous until the diabetic ketoacidosis under control. Outcomes: He achieved the near-nomalglycemic remission uneventfully. At 12-month follow-up, his treatment was adjusted from insulin subcutaneous injection to oral hypoglycemic drugs. Lesson: The present study of this obese adolescent with negative auto-antibodies but unprovoked diabetic ketoacidosis and partially preserved beta cell functional reserve after the acute of diabetic ketosis suggested that he has the phenotype of “A–β + ” KPDM. Further study of this syndrome will help illustrate the inadequacy of current classification and targeted therapies.

show abstract

Section: Discussionmentioning

confidence: 99%

Ketosis-prone diabetes mellitus in an obese adolescent

Tan

Wang

2019

Medicine

View full text Add to dashboard Cite

show abstract

Section: Case Descriptionsmentioning

confidence: 99%

“…5 6 13 Novel etiologies have been uncovered for the ketosis proneness of patients with unprovoked A − B + ketotic diabetes (eg, such as this patient), including hypercatabolism of leucine/isoleucine 14 and defective intracellular availability of arginine. 15 In the broader context of A − B + ketotic diabetes, 'occult' islet autoimmunity (in the shape of T cell-mediated β-cell dysfunction) also can occur. 16 For long-term treatment, there are now far more attractive alternatives than insulin to achieve a powerful antidiabetic effect in T2D without the risk of hypoglycemia and with weight loss instead of weight gain.…”

Section: Introductionmentioning

confidence: 99%

Atypical diabetes: a diagnostic challenge

Sjöholm¹

2020

BMJ Open Diab Res Care

View full text Add to dashboard Cite

In medical school, we learned how to classify diabetes according to different clinical characteristics. However, at the dawn of the precision medicine era, it is clear that today’s clinical reality does not always align well with textbook teachings. The terms juvenile versus elderly-onset diabetes, as well as insulin-dependent versus non-insulin-dependent diabetes, have become obsolete. Contrary to what is often taught severe ketoacidosis may occur in type 2 diabetes. Patients may also suffer from two or more forms of diabetes simultaneously or consecutively. Five authentic cases of diabetes with uncommon characteristics that pose diagnostic challenges are presented here.

show abstract

“… 16. , 17. Interestingly, associations of ‘provoked KPD’ with viral infections, notably HINI influenza and HHV-8, have been reported.…”

Section: Introductionmentioning

confidence: 99%

Characterizing progressive beta-cell recovery after new-onset DKA in COVID-19 provoked A-β+ KPD (ketosis-prone diabetes): A prospective study from Eastern India

Gupta¹,

Atri

Mondal³

et al. 2022

Journal of Diabetes and its Complications

View full text Add to dashboard Cite

Background Recent literature suggests a bi-directional relationship between COVID-19 infection and diabetes mellitus, with an increasing number of previously normoglycemic adults with COVID-19 being admitted with new-onset diabetic ketoacidosis (DKA). However, the possibility of COVID-19 being a potential trigger for A-β + ketosis-prone diabetes (KPD) in these patients needs elucidation. Our study aimed at analyzing such a cohort of patients and determining their natural course of β-cell recovery on serial follow-up. Methods After initial screening, n = 42 previously non-diabetic patients with new-onset DKA and RT-PCR positive COVID-19, were included in our ten-month follow-up study. Of these, n = 22 were negative (suspected A-β + KPD) and n = 20 were positive (Type 1A DM) for autoantibodies (GAD/IA-2/ZnT8). Subsequently, n = 19 suspected KPD and n = 18 Type 1A DM patients were followed-up over ten months with serial assessments of clinical, biochemical and β-cell secretion. Amongst the former, n = 15 (79%) patients achieved insulin independence, while n = 4 (21%) continued to require insulin at ten-months follow-up. Results On comparison, the suspected KPD patients showed significantly greater BMI, age, Hba1c, IL-6 and worse DKA parameters at presentation. Serial C-peptide estimations demonstrated significant β-cell recovery in KPD group, with complete recovery seen in the 15 patients who became insulin independent on follow-up. Younger age, lower BMI, initial severity of DKA and inflammation (IL-6 levels), along-with reduced 25-hydroxy-Vitamin-D levels were associated with poorer recovery of β-cell secretion at ten-month follow-up amongst the KPD patients, Conclusions This is the first prospective study to demonstrate progressive recovery of β-cell secretion in new-onset A-β + KPD provoked by COVID-19 infection in Indian adults, with a distinctly different profile from Type 1A DM. Given their significant potential for β-cell recovery, meticulous follow-up involving C-peptide estimations can help guide treatment and avoid injudicious use of insulin.

show abstract

Arginine Metabolism Is Altered in Adults with A-β + Ketosis-Prone Diabetes

Cited by 15 publications

References 29 publications

Ketosis-prone diabetes mellitus in an obese adolescent

Ketosis-prone diabetes mellitus in an obese adolescent

Atypical diabetes: a diagnostic challenge

Characterizing progressive beta-cell recovery after new-onset DKA in COVID-19 provoked A-β+ KPD (ketosis-prone diabetes): A prospective study from Eastern India

Contact Info

Product

Resources

About