Diabetes Mellitus tipo 2 con tendencia a la cetosis: Caso clínico

L, Luciana Concha; A, Pilar Durruty; A, Manuel García de los Ríos

doi:10.4067/s0034-98872015000900017

Cited by 6 publications

(4 citation statements)

References 15 publications

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“…In fact, KPD in near-normoglycemic remission displayed muscle, adipose tissue and hepatic insulin resistance, residual insulin secretion, as well as inappropriate glucagon secretion [11–13]. KPD is associated with an acute, reversible dysfunction of β-cell function [14, 15]. There is no evidence of association between DRB1 DQB1 genetic profile susceptibility in people with KPD [16].…”

Section: Introductionmentioning

confidence: 99%

Acute phase ketosis-prone atypical diabetes is associated with a pro-inflammatory profile: a case-control study in a sub-Saharan African population

Lontchi-Yimagou

Boudou

Nguewa

et al. 2018

J Diabetes Metab Disord

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Background It is unknown whether inflammation plays a role in metabolic dysfunction on ketosis-prone diabetes (KPD). We aimed to assess the inflammatory profile in sub-Saharan African patients with KPD during the acute ketotic phase as well as during non-ketotic hyperglycemic crises. Methods We studied 72 patients with non-autoimmune diabetes: 23 with type 2 diabetes mellitus (T2D), and 49 with KPD, all admitted in hyperglycemic crisis (plasma glucose ≥250 mg/dl). The T2D and KPD groups were matched by sex, age, and Body Mass Index. KPD was sub-classified into new-onset ketotic phase ( n = 34) or non-ketotic phase ( n = 15). We measured TNF-α, MCP-1, MIP1-α, IL-8, MIP1-β, and VEGF in the serum of all participants. Results TNF-α and IL-8 were higher in participants with KPD compared to those with T2D ( p = 0.02 TNF-α; p = 0.03 IL-8). TNF-α and IL-8 were also higher in the ketotic phase KPD group compared to the T2D group ( p = 0.03 TNF-α; p < 0.001 IL-8) while MIP1-α was lower in people with ketotic phase KPD compared to their T2D counterparts ( p = 0.03). MIP1-α was lower in the ketotic phase KPD group compared to the non-ketotic phase KPD group ( p = 0.04). MCP-1 was lower in non-ketotic phase KPD compared to T2D ( p = 0.04), and IL-8 was higher in non-ketotic phase KPD compared to T2D ( p = 0.02). Conclusions Participants with KPD had elevated pro-inflammatory cytokines compared to their T2D counterparts. Ketotic phase KPD is associated with a different pro-inflammatory profile compared to non-ketotic phase KPD, and the inflammatory profile appears to be comparable between non-ketotic phase KPD and T2D patients.

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Section: Introductionmentioning

confidence: 99%

Acute phase ketosis-prone atypical diabetes is associated with a pro-inflammatory profile: a case-control study in a sub-Saharan African population

Lontchi-Yimagou

Boudou

Nguewa

et al. 2018

J Diabetes Metab Disord

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“…[5] KPDM is an emerging heterogeneous syndrome. [6,9,13–15] This syndrome of episodic diabetic ketoacidosis without immunologic markers of type 1 diabetes is characterized by insulin dependence at the time of presentation, but followed by absence of insulin requirements for years as observed in type 2 diabetes. [16] Because of the mixed features of type 1 and type 2 diabetes, this variant of diabetes has been referred to in the literature as diabetes type 1B, idiopathic type 1 diabetes, atypical diabetes, Flatbush diabetes, and more recently, ketosis-prone type 2 diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…[2–5] KPDM was found be with mix characteristics of classic type 1 and type 2 diabetes. [6] Here, we present a clinical observation of an adolescent with new-onset ketosis prone diabetes, which illustrates the insufficiencies of the current classifications.…”

Section: Introductionmentioning

confidence: 99%

Ketosis-prone diabetes mellitus in an obese adolescent

Tan

Wang

2019

Medicine

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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.

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“…En contraste au diabète de type 1, le diabète de type 2 est dû à une insulinorésistance avec une défaillance relative de l’insulinosécrétion [7, 11]. Certains patients se présentent dans un tableau d’acidocétose diabétique mais qui recouvrent avec le temps une capacité sécrétoire de la cellule Beta pancréatique [12-14]. Malgré la haute prévalence du diabète cétosique décrite dans le monde [1], il existe très peu d’informations concernant l’épidémiologie de cette complication en Tunisie.…”

Section: Introductionunclassified

Etude sur le diabète aigu cétosique inaugural dans un hôpital du Centre-Est Tunisien

Ach¹,

Cheikh²,

Hasni³

et al. 2018

Pan Afr Med J

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La cétose est une complication aiguë du diabète qui consiste en une accumulation de corps cétoniques sanguins. Malgré la haute prévalence du diabète cétosique décrite, il existe très peu d’informations concernant l’épidémiologie de cette complication inaugurale du diabète en Tunisie. L’objectif était de déterminer les caractéristiques épidémiologiques et clinico-biologiques des cétoses inaugurales dans un hôpital du Centre-Est tunisien. Il s’agit d’une étude rétrospective, transversale et exhaustive, à propos de patients admis pour une cétose inaugurale sur une période allant de janvier 2010 à août 2016. La population d’étude a été divisée en 2 groupes selon la présence ou pas d’une auto-immunité anti pancréatique: groupe DAI (diabète de type 1 auto-immun) regroupe tous les patients avec une auto-immunité, et le groupe DNAI (diabète cétosique non auto-immuns) sans auto-immunité. Il s’agit de 391 patients, de sex ratio 266 hommes/125 femmes, d’âge moyen de 34±14,33 ans. La prédominance masculine était nette: 68% dans la population générale. L’âge de la cétose était significativement plus précoce dans le groupe DAI. Un facteur précipitant la cétose était retrouvé chez 77,7% de la population globale d’étude, significativement plus fréquent dans le groupe DAI que dans le groupe DNAI. Le facteur le plus retrouvé était les infections virales. Les Anticorps anti thyroïdiens étaient significativement importants dans le groupe DAI. La cétose est un facteur de décompensation inaugurale fréquent du diabète en Tunisie. La population la plus importante a été décrite chez l’adulte jeune masculin, avec l’absence d’une auto-immunité, et un profil clinique du diabète de type 2.

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Diabetes Mellitus tipo 2 con tendencia a la cetosis: Caso clínico

Abstract: (Rev Med Chile 2015; 143: 1215-1218

Cited by 6 publications

References 15 publications

Acute phase ketosis-prone atypical diabetes is associated with a pro-inflammatory profile: a case-control study in a sub-Saharan African population

Acute phase ketosis-prone atypical diabetes is associated with a pro-inflammatory profile: a case-control study in a sub-Saharan African population

Ketosis-prone diabetes mellitus in an obese adolescent

Etude sur le diabète aigu cétosique inaugural dans un hôpital du Centre-Est Tunisien

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