Endocrine Abstracts

Introduction: A new subtype of diabetes, ketosis-prone diabetes (KPD) has been described in the last years among African, Asian and Hispanic population with characteristics similar to type 1 diabetes (DM1) such as cardinal symptoms, tendency to ketosis and decreased pancreatic reserve at onset, but with negative autoimmunity. The aim of this study was to compare this type of patients with those with type 1 diabetes at onset and their evolution.

Material and methods: Retrospective study with the last 14 admissions by KPD of new onset in our hospital, in comparison with the last 14 DM1. We collected personal and family history, demographic, anthropometric, analytical and treatment variables. The statistical program SPSS was used.

Results: The mean age of the KDP group was 43.21 years vs 28.54 in DM1 patients with significant differences between both groups (P 0.0001). In the first group, 92.9% were men vs 69.2% of the second, without significant differences. Most patients with KPD came from African countries (Gambia, Senegal, Morocco) and all of them had anti-GAD antibodies negative at diagnosis. No differences were found regarding family history of diabetes or presence of concomitant diseases. A higher prevalence of autoimmune diseases was observed in DM1 (vitiligo, celiac disease, autoimmune hypothyroidism (2)). The mean weight of the first group was 77.21 kg vs 63.96 kg (P<0.05), without significant differences in BMI (24.34 kg/m² vs 21.55 kg/m², P 0.09). Duration of cardinal clinic was shorter in the KPD group (2.85 weeks vs 6.38, P 0.01). Regarding analytical values at admission, differences were found in C peptide (0.84 vs 0.47, P 0.04) and bicarbonate (25.7 vs 19.3, P 0.02), without differences in the rest parameters studied (pH, ketone bodies, glycemia, creatinine, HbA1C (13.03% and 12.86%), triglycerides, cholesterol and liver profile). The insulin dose at discharge was higher in the group with KPD (45.57 UI/d vs. 30.77 UI/d, P 0.019), but 6 months after diagnosis, only 28.6% of patients with KPD continued to require insulin treatment vs 100% of DM1, without differences in HbA1C between both groups (6.49% vs. 6.58%, P 0.87). Of the KPD without insulin treatment, 80% required oral medication for diabetes and 20% did not need treatment.

Conclusions: In our study, KPD presents a more abrupt onset and at a later age than DM1. All patients required basal-bolus treatment at the beginning, but in most of them it could be removed after 6 months, with good glycemic control.