P323Insulin requirements in patients with ketosis‐prone Type 2 diabetes presenting acutely to an urban diabetes centreA BHALLA1, G Noble‐Bell2, R Malik2, C Gayle2, MB Whyte21Medicine, King's College Hospital, Denmark Hill, London, UK, 2Diabetes, King's College Hospital, Denmark Hill, London, UKAims: Ketosis‐prone diabetes (KPDM) describes hyperglycaemic ketosis with negative autoantibodies and long‐term remission from insulin. KPDM is considered primarily a result of acute beta cell failure. We reviewed phenotypic features and insulin‐dose requirements at hospital discharge as a surrogate measure of insulin resistance, in newly diagnosed antibody‐negative diabetes, with/without significant ketosis.Methods: Data collected from patients admitted with ketone‐positive symptomatic hyperglycaemia at an urban hospital. All cases were insulin naive on admission with glucose > 12mmol/l and (later) negative for GAD and ICA antibody. KPDM (n = 18) had admission pH ≤7.30, bicarbonate ≤15mmol/l and urinary ketones ≥80mg/dl. Ketosis‐only (KO; n = 29) had ketones ≥80mg/dl but pH >7.30. Type 2 diabetes (n = 20) had ketones ≤40mg/dl. Data are mean ± SEM unless stated.Results: Of 67 patients, there were no differences between groups in age (overall mean 45.4 ± 2.1 years), gender (males n = 55, 82%), or ethnicity (Afro‐Caribbeans most numerous; n = 53; 79%). HbA1c was 13.7 ± 0.7% in KPDM, 13.7 ± 0.4% in KO, 12.5 ± 0.6% in Type 2 diabetes; p = 0.226. Admission glucose was 47.6 ± 4.8 mmol/l KPDM, 21.9 ± 1.8 mmol/l KO, 32.5 ± 2.8 mmol/l Type 2 diabetes; p = 0.401). Creatinine was higher in KPDM 169.3 ± 16.7 µmol/l than KO (110.1 ± 6.7 µmol/l; p = 0.001) not Type 2 diabetes (132.5 ± 10.3 µmol/l; p = 0.055). Despite comparable body mass index (33.8 ± 1.6 kg/m2 KPDM, 29.5 ± 1.2 kg/m2 KO, 32.1 ± 1.6 kg/m2 Type 2 diabetes; p = 0.054), insulin dose at hospital discharge was higher in KPDM (0.60 ± 0.05 units/kg/day) than KO (0.44 ± 0.05 units/kg/day; p = 0.012) but not vs Type 2 diabetes (0.58 ± 0.06units/kg/day; p = 0.443). This was not accounted for by difference in aspartate aminotransferase (overall median 22.5iU/l, IQR 17 to 32) or CRP (median 7.2mg/l, IQR 0 to 13.4).Conclusions: In the acute setting, KPDM appears to exhibit a similar degree of insulin resistance to Type 2 diabetes but more resistant than KO.
Diabetic Medicine – Wiley
Published: Jan 1, 2018
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