title: Ketosis-prone atypical diabetes in Cameroonian people with hyperglycaemic crisis: frequency, clinical and metabolic phenotypes.
abstract: It is unclear whether ketosis-prone diabetes is a specific type or a subtype of Type 2 diabetes. We aimed to describe the clinical and metabolic features of ketosis-prone diabetes in a sub-Saharan population.
  
  
  
  We consecutively enrolled and characterized 173 people with non-autoimmune diabetes admitted for hyperglycaemic crisis at the Yaoundé Central Hospital, Cameroon. Blood samples were collected for fasting glucose, HbA1c, lipid profile and C-peptide assays with insulin resistance and secretion estimation by homeostasis model assessment. People were classified as having Type 2 diabetes (n = 124) or ketosis-prone diabetes (n = 49). Ketosis-prone diabetes was sub-classified as new-onset ketotic phase (n = 34) or non-ketotic phase (n = 15).
  
  
  
  Ketosis-prone diabetes was found in 28.3% of the hyperglycaemic crises. Age at diabetes diagnosis was comparable in Type 2 and ketosis-prone diabetes [48 ± 14 vs 47 ± 11 years; P = 0.13] with a similar sex distribution. Overall BMI was 27.7 ± 13.4 kg/m2and was ≥ 25 kg/m2in 55.8% of those taking part, however, 73.5% of those with ketosis-prone diabetes reported weight loss of > 5% at diagnosis. Blood pressure and lipid profile were comparable in both types. Ketosis-prone diabetes in the ketotic phase was characterized by lower insulin secretion and higher serum triglycerides compared with non-ketotic ketosis prone and Type 2 diabetes. Type 2 and ketosis prone diabetes in the non-ketotic phase were comparable in terms of lipid profile, blood pressure, waist-to-hip ratio, BMI and fat mass, insulin secretion and insulin resistance indices.
  
  
  
  Ketosis-prone diabetes is likely to be a subtype of Type 2 diabetes with the potential to develop acute insulinopenic episodes.
authors.affiliation: Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon.
authors.forename: E
authors.initials: E
authors.lastname: Lontchi-Yimagou
authors.affiliation: INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France.
authors.forename: J L
authors.initials: JL
authors.lastname: Nguewa
authors.affiliation: National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon.
authors.forename: F
authors.initials: F
authors.lastname: Assah
authors.affiliation: Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
authors.forename: J J
authors.initials: JJ
authors.lastname: Noubiap
authors.affiliation: Saint-Louis University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Boudou
authors.affiliation: National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon.
authors.forename: E
authors.initials: E
authors.lastname: Djahmeni
authors.affiliation: Diabetes Research Center, Brussels Free University-VUB, Brussels, Belgium.
authors.forename: E V
authors.initials: EV
authors.lastname: Balti
authors.affiliation: Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon.
authors.forename: B
authors.initials: B
authors.lastname: Atogho-Tiedeu
authors.affiliation: INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France.|Saint-Louis University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
authors.forename: J F
authors.initials: JF
authors.lastname: Gautier
authors.affiliation: Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon.|National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon.|Department of Internal Medicine, University of Yaoundé I, Yaoundé, Cameroon.
authors.forename: J C
authors.initials: JC
authors.lastname: Mbanya
authors.affiliation: Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon.|National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon.|Department of Internal Medicine, University of Yaoundé I, Yaoundé, Cameroon.
authors.forename: E
authors.initials: E
authors.lastname: Sobngwi
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002163:Cameroon; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000208:ethnology / Q000378:metabolism / Q000628:therapy; D016883:Diabetic Ketoacidosis / Q000175:diagnosis* / Q000208:ethnology / Q000378:metabolism / Q000628:therapy; D003937:Diagnosis, Differential; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006786:Hospitals, Urban; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007328:Insulin / Q000097:blood / Q000378:metabolism; D007333:Insulin Resistance / Q000208:ethnology; D000078790:Insulin Secretion; D050417:Insulin-Secreting Cells / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation
chemical_list: D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human