Glycemic instability in type 1 diabetic patients: Possible role of ketosis or ketoacidosis at onset of diabetes.
OBJECTIVE
In type 1 diabetic patients, some have glycemic instability while others glycemic stability. We have developed criteria for evaluating glycemic instability and investigated the factors responsible.


METHODS
Glycemic instability in 52 type 1 diabetic patients was assessed by the mean amplitude of glycemic excursions (MAGE) and M-value, and clinical characteristics of good, fair and poor control groups were compared.


RESULTS
The median MAGE and M-value was 6.6mmol/L and 18.7, respectively. Then MAGE >or=6.6mmol/L and M-value >or=18.7 was defined as poor control. In the 32 patients without detectable C-peptide levels, 18 patients (56%) showed poor control. The frequency of ketosis or ketoacidosis at onset of diabetes was dramatically higher in the poor control group not only in the patients as a whole but also in those without detectable C-peptide levels.


CONCLUSIONS
A decreased level of C-peptide is a significant factor in glycemic instability. However, some patients have glycemic stability though beta-cell function is completely depleted. The presence of ketosis or ketoacidosis at onset of diabetes may be a factor in later glycemic instability, suggesting the importance of examining patients in detail at onset of diabetes for careful follow-up to prevent progression of acute and chronic complications of diabetes.
Department of Diabetes and Clinical Nutrition, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
Mariko
M
Sassa
Yuichiro
Y
Yamada
Masaya
M
Hosokawa
Kazuhito
K
Fukuda
Shimpei
S
Fujimoto
Kentaro
K
Toyoda
Katsushi
K
Tsukiyama
Yutaka
Y
Seino
Nobuya
N
Inagaki
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D002096:C-Peptide / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications; D016883:Diabetic Ketoacidosis / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006706:Homeostasis; D006801:Humans; D008297:Male; D008875:Middle Aged
D001323:Autoantibodies; D015415:Biomarkers; D001786:Blood Glucose; D002096:C-Peptide