One third of cases of new‐onset diabetic ketosis in adults are associated with ketosis‐prone type 2 diabetes—A systematic review and meta‐analysis

Abstract

AimsKetosis‐prone type 2 diabetes was defined by the World Health Organization in 2019. According to the literature, the diagnosis is based on the presence of ketosis, islet autoantibody negativity and preserved insulin secretion. Our meta‐analysis assessed the prevalence and clinical characteristics of ketosis‐prone type 2 diabetes among patients hospitalised with diabetic ketoacidosis (DKA) or ketosis.MethodsThe systematic search was performed in five main databases as of 15 October 2021 without restrictions. We calculated the pooled prevalence of ketosis‐prone type 2 diabetes (exposed group) within the diabetic population under examination, patients with ketoacidosis or ketosis, to identify the clinical characteristics, and we compared it to type 1 diabetes (the comparator group). The random effects model provided pooled estimates as prevalence, odds ratio and mean difference (MD) with 95% confidence intervals.ResultsEleven articles were eligible for meta‐analysis, thus incorporating 2010 patients of various ethnic backgrounds. Among patients presenting with DKA or ketosis at the onset of diabetes, 35% (95% CI: 24%–49%) had ketosis‐prone type 2 diabetes. These patients were older (MD = 11.55 years; 95% CI: 5.5–17.6) and had a significantly higher body mass index (BMI) (MD = 5.48 kg/m2; 95% CI: 3.25–7.72) than those with type 1 diabetes.ConclusionsKetosis‐prone type 2 diabetes accounts for one third of DKA or ketosis at the onset of diabetes in adults. These patients are characterised by islet autoantibody negativity and preserved insulin secretion. They are older and have a higher BMI compared with type 1 diabetes. C‐peptide and diabetes‐related autoantibody measurement is essential to identify this subgroup among patients with ketosis at the onset of diabetes.