[Clinical characteristics and outcome of adult diabetic patients with ketosis as the initial manifestation: a follow-up study].
OBJECTIVE
To study the clinical characteristics and natural history of adult diabetic patients with ketosis as the initial manifestation.


METHODS
In 60 patients with ketosis as the initial symptom, the mean age was (42.78+/-11.14) years and body mass index(BMI) was (2.34+/-3.47) kg/m2. The islet cell antibody (ICA), anti-glutamic acid decarboxylase (GAD) antibody, fast plasma glucose and insulin level, glucose and insulin level of 2 hours after oral glucose test were measured. After insulin therapy, these patients received therapy plan according to their glucose level. During follow-up period, these items were tested again.


RESULTS
There were 27 patients using insulin and 33 patients using diet or oral hypoglycemic drugs for controlling blood glucose during the follow-up. Compared with patients using insulin therapy, patients using oral hypoglycemic drugs or diet therapy showed higher BMI (at onset of ketosis (25.69+/-2.66) kg/m2 vs. (22.64+/-3.75) kg/m2, P=0.001; during follow-up period (26.19+/-3.11) kg/m2 vs. (22.29+/-2.97) kg/m2, P=0.000), higher post-load serum insulin level (at onset of ketosis (32.39+/-35.87) mU/L vs. (18.53+/-14.43) mU/L, P=0.017; during follow-up period (67.34+/-68.42) mU/L vs. (36.40+/-45.39) mU/L, P=0.004), lower HbA 1C (at onset of ketosis (10.76+/-1.25) percent vs. (12.04+/-1.99) percent, P=0.006; during follow-up period (6.97+/-1.31)percent vs. (9.36+/-3.18) percent, P=0.000), higher percentage of ICA and GAD positivity (at onset of ketosis, ICA positive rate was 18.52 percent vs. 0, P=0.030, GAD positive rate was 18.52 percent vs. 0, P=0.030; during follow-up period, ICA positive rate was 7.41 percent vs. 0, P=0.111, GAD positive rate was 14.81 percent vs. 0, P=0.022).


CONCLUSIONS
Among the adult diabetic patients with ketosis as the first symptom, quite a number of patients are not insulin dependent for the long-term blood sugar control. Ketosis is not a good index for differentiating type 1 from type 2 diabetes.
Cai
Xiao-ling
XL
Department of Endocrinology and Metabolism, People's Hospital, Peking University, Beijing 100044, China.
Ji
Li-nong
LN
D000293:Adolescent; D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000628:therapy; D004032:Diet; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007328:Insulin / Q000097:blood / Q000627:therapeutic use*; D007662:Ketosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis
D001323:Autoantibodies; D001786:Blood Glucose; D007328:Insulin; C024211:islet cell antibody