Endocrine Abstracts

Ketosis-prone, Jamaica (J) type diabetes is an uncommon form of diabetes described in a sub-population of mainly Afro-Caribbean patients who often present acutely with diabetic ketoacidosis (DKA) but during follow up demonstrate clinical, metabolic, and immunologic features of Type II diabetes. We present such a case.

A 37-year old Afro-Caribbean man with a family history of Type II diabetes presented with polyuria, polydipsia and weight loss. He was overweight (body mass index 29) and clinically dehydrated. Blood glucose was 31.1 mmol/l, urine had 3+ ketones and arterial blood gases showed compensated metabolic acidosis. He was treated as DKA, recovering sufficiently within 48 h and was discharged on a basal bolus insulin regime. This regime underwent minor adjustments and glycated haemoglobin 6 months after diagnosis had fallen to 6.9% from 14.0%. Glutamic acid decarboxylase (GAD) antibodies were negative. His insulin requirements gradually diminished over the next few months until he was taken off insulin completely whilst maintaining near normal glycaemia on Metformin only.

The prevalence of this type of diabetes is not known but thought to be between 20 and 50% in African–American and Hispanic patients in the USA and 40–60% in Africa. Majority of patients are middle-aged overweight males. At presentation, they have markedly impaired insulin secretion and action, but intense anti-diabetic management results in significant improvement in beta-cell function and insulin sensitivity, allowing discontinuation of insulin therapy within a few months of follow-up (remission may last months to several years). The absence of autoimmune markers and the presence of measurable insulin secretion have proven useful in predicting near-normoglycemic remission and long-term insulin dependence in adult patients with a history of DKA. Unlike patients with Type II diabetes presenting with DKA, these patients may not require long-term insulin treatment. Awareness of this entity is essential for proper long-term management and follow-up.