title: Presence of the metabolic syndrome distinguishes patients with ketosis-prone diabetes who have a Type 2 diabetic phenotype.
abstract: OBJECTIVE
  This study was designed to determine if patients with ketosis-prone diabetes could be distinguished clinically on the basis of features of the metabolic syndrome (MetS).
  
  
  METHODS
  Participants with ketosis-prone diabetes admitted to our institution during a 3-year period were studied. One hundred seventy-two patients from four ethnic backgrounds were divided into two groups: with or without MetS, as defined by the World Health Organization. Pearson's chi-square test or one-way ANOVA was used as appropriate to evaluate group differences.
  
  
  RESULTS
  Of the 172 patients, 74 (43%) had at least three characteristics of MetS (+MetS group), while 98 (57%) had less than three characteristics of MetS (-MetS group). The +MetS group had significantly higher beta-cell functional reserve as measured by the glucagon stimulation test [area under the curve (AUC) for C-peptide levels 19.50+/-2.26 compared with 8.66+/-1.66 ng/ml over 10 min; P=.0001]. A significantly higher proportion of patients in the +MetS group had preserved beta-cell functional reserve than in the -MetS group (70% compared with 30%; P<.00001). After 12 months of follow-up, +MetS patients had significantly lower HbA1c levels (8.3+/-0.4% compared with 9.8+/-0.4%; P=.01) and higher C-peptide/glucose ratios (2.01+/-0.28 compared with 1.14+/-0.21; P=.02) than the -MetS patients did.
  
  
  CONCLUSIONS
  Patients with ketosis-prone diabetes with the MetS are more likely to have features associated with Type 2 diabetes, despite having developed diabetic ketoacidosis (DKA), with better beta-cell functional reserve and glycemic control after the index DKA episode.
authors.affiliation: Division of Endocrinology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Max E
authors.initials: ME
authors.lastname: Otiniano
authors.forename: Ashok
authors.initials: A
authors.lastname: Balasubramanyam
authors.forename: Mario
authors.initials: M
authors.lastname: Maldonado
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002096:C-Peptide / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000378:metabolism; D016883:Diabetic Ketoacidosis / Q000175:diagnosis* / Q000378:metabolism; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D005934:Glucagon / Q000378:metabolism; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis* / Q000378:metabolism; D010641:Phenotype; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D005934:Glucagon; D006442:Glycated Hemoglobin