title: Severe diabetes in remission: a Singapore's perspective.
abstract: BACKGROUND
  Diabetic ketoacidosis is generally thought to be the classical presentation of individuals with Type 1 diabetes. Clinicians are beginning to see individuals with atypical diabetes presenting with severe hyperglycaemia associated with or without ketosis and after the initial period of intensive insulin therapy, becoming non-insulin dependent and remaining in remission for years. So far, these patients have only been identified amongst African Americans and have only recently been reported amongst the Japanese and the Chinese in Hong Kong. We therefore set out to identify the existence of such patients in our population.
  
  
  METHODS
  We have a database of patients admitted for diabetic ketoacidosis. From this, we recruited patients who fulfilled the criteria for atypical diabetes and proceeded to perform a retrospective analysis together with a prospective analysis of their outcome.
  
  
  RESULTS
  We identified 10 individuals with atypical diabetes with characteristics similar to those previously described. Our data showed that these patients deferred from classical individuals with Type 1 diabetes in the following ways--older age of onset, relatively higher BMI, marked elevation in HBA1c suggesting a significant period and degree of hyperglycaemia and prolonged remission after reversal of hyperglycaemia.
  
  
  CONCLUSIONS
  Atypical Type 2 diabetes exists in our population. Clinicians looking after individuals with diabetes should be made aware of this as there are important implications in the subsequent management of such patients.
authors.affiliation: Department of Endocrinology, Singapore General Hospital, Outram Road, Singapore 169608. gecthh@sgh.gov.sg
authors.forename: H H
authors.initials: HH
authors.lastname: Tan
authors.forename: H S
authors.initials: HS
authors.lastname: Lim
authors.forename: S C
authors.initials: SC
authors.lastname: Lim
mesh_terms: D000328:Adult; D017668:Age of Onset; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012074:Remission Induction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012846:Singapore / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin