Ketosis-prone diabetes: dissection of a heterogeneous syndrome using an immunogenetic and beta-cell functional classification, prospective analysis, and clinical outcomes.
Ketosis-prone diabetes is heterogeneous. Its causes could include novel beta-cell functional defects. To characterize such defects, 103 patients with diabetic ketoacidosis were evaluated for beta-cell autoimmunity and human leukocyte antigen (HLA) class II alleles, with longitudinal measurements of beta-cell function and biochemical and clinical parameters. They were classified into four A beta groups, based on the presence of glutamic acid decarboxylase (GAD)65, GAD67, or IA-2 autoantibodies (A+ or A-) and beta-cell functional reserve (beta+ or beta-). The group distribution was: 18 A+beta-, 23 A-beta-, 11 A+beta+, and 51 A-beta+. Collectively, the two beta- groups differed from the two beta+ groups in earlier onset and longer duration of diabetes, lower body mass index, less glycemic improvement, and persistent insulin requirement. HLA class II genotyping showed that the A-beta- group differed from the A+beta- group in having lower frequencies of two alleles strongly associated with autoimmune type 1 diabetes susceptibility: DQA*03 and DQB1*02. Similarly, the A-beta+ group differed from the A+beta+ group in having a lower frequency of DQB1*02. Ketosis-prone diabetes comprises at least four etiologically distinct syndromes separable by autoantibody status, HLA genotype, and beta-cell functional reserve. Novel, nonautoimmune causes of beta-cell dysfunction are likely to underlie the A-beta+ and A-beta- syndromes.
Maldonado
Mario
M
Division of Endocrinology, Department of Medicine, Baylor College of Medicine, Houston, Texas 77030, USA.
Hampe
Christiane S
CS
Gaur
Lakshmi K
LK
D'Amico
Susana
S
Iyer
Dinakar
D
Hammerle
Lisa P
LP
Bolgiano
Douglas
D
Rodriguez
Lucille
L
Rajan
Arun
A
Lernmark
Ake
A
Balasubramanyam
Ashok
A
D000293:Adolescent; D000328:Adult; D001323:Autoantibodies / Q000097:blood; D001786:Blood Glucose; D003922:Diabetes Mellitus, Type 1 / Q000145:classification* / Q000208:ethnology / Q000235:genetics / Q000276:immunology; D003924:Diabetes Mellitus, Type 2 / Q000145:classification* / Q000208:ethnology / Q000235:genetics / Q000276:immunology; D016883:Diabetic Ketoacidosis / Q000145:classification* / Q000208:ethnology / Q000235:genetics / Q000276:immunology; D005006:Ethnicity; D005260:Female; D005787:Gene Frequency; D005968:Glutamate Decarboxylase / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007515:Islets of Langerhans / Q000276:immunology*; D007527:Isoenzymes / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests
D001323:Autoantibodies; D001786:Blood Glucose; D007527:Isoenzymes; D005968:Glutamate Decarboxylase; C402565:glutamate decarboxylase 1; C401141:glutamate decarboxylase 2