title: Should diabetic ketosis without acidosis be included in ketosis-prone type 2 diabetes mellitus?
abstract: BACKGROUND
  The incidence of ketosis-prone type 2 diabetes is very low except for people of sub-Saharan African origin and African Americans. However, there also are some type 2 diabetes patients with diabetic ketosis without acidosis (DKWA). We question whether DKWA should be included as a subtype of ketosis-prone type 2 diabetes mellitus and compared the clinical characteristics of DKWA and diabetic ketoacidosis (DKA) patients.
  
  
  METHODS
  The study population consisted of 594 consecutive unrelated Chinese inpatients with newly diagnosed type 2 diabetes. Demographic and clinical characteristics (age, gender, family history of diabetes, body mass index, blood pressure and plasma lipid parameters) were recorded. The patients were divided into ketosis-resistant diabetes (KRD), DKWA and DKA groups on the basis of urinary ketones, blood pH and bicarbonate levels. The blood glucose and c-peptide levels of the patients were also evaluated.
  
  
  RESULTS
  The prevalence of KRD, DKWA and DKA were 78.33%, 19.72% and 1.95%, respectively, in the study population. The clinical characteristics of patients with DKWA group patients were similar to those with DKA, except that DKA patients had higher blood glucose and deteriorated β cell function.
  
  
  CONCLUSIONS
  Diabetic ketosis without acidosis and DKA patients share similar clinical characteristics; DKWA should be considered ketosis-prone type 2 diabetes. Therefore, the prevalence of ketosis-prone type 2 diabetes might be underestimated.
authors.affiliation: Department of Endocrinology, Nanjing First Hospital Affiliated to Nanjing Medical University, 68 ChangLe St., Nanjing, China.
authors.forename: Xiao-Jing
authors.initials: XJ
authors.lastname: Xie
authors.forename: Yun
authors.initials: Y
authors.lastname: Hu
authors.forename: Cheng
authors.initials: C
authors.lastname: Cheng
authors.forename: Tian-Tian
authors.initials: TT
authors.lastname: Feng
authors.forename: Ke
authors.initials: K
authors.lastname: He
authors.forename: Xiao-Ming
authors.initials: XM
authors.lastname: Mao
mesh_terms: D000138:Acidosis / Q000453:epidemiology; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000378:metabolism; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000453:epidemiology* / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology* / Q000378:metabolism; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D017678:Sex Distribution; D012737:Sex Factors
chemical_list: D001786:Blood Glucose; D002096:C-Peptide
keywords: clinical characteristics; diabetic ketosis without acidosis; ketosis-prone type 2 diabetes; prevalence