Endocrine Abstracts

Introduction: Prevalence of so-called diabetes prone to ketosis (DPK), has been increasing. The necessity of lifelong insulinotherapy is determined by Aβ classification of DPK.

Design: Seven patients with atypical course of T2DM were studied. All patients had gradual development of hyperglycemia, obesity 1–2 stages, and acetonuria. Noone had acute weight loss. Stage 3 had positive GAD-AB, stage 4 – negative. Initially all patients were treated by insulin during 2–3 weeks. Thereafter, C-peptide was determined and type of diabetes, prone to ketosis, was established. If C-peptide was more than 1.2 ng/ml, oral hypoglycemic drugs were prescribed. Patients were followed up during 1 year with studying BMI, C-peptide, HbA1c, and acetonuria.

Results: Three patients had diagnosis of A+β+DPK and took oral medicine. However, during 1-year follow up, all these patients had HbA1c greater 7.5%, unmotivated weight loss and periodical acetonuria. After 6-month of follow up C-peptide was <1.2 ng/ml at all patients, which was an indication to lifelong insulinotherapy. Four patients were diagnosed with DPK A−β+ and took oral medicine. During 1-year follow up, 2 patients had HbA1c <7.5% and no cases of acetonuria. With stable weight, the level of C-peptide was still >1.2 ng/ml at the end of follow up. Thus, the prescribed treatment with oral hypoglycemic agents were continued. Two patients had HbA1c >7.5%, frequent cases of acetonuria and significant weight loss. C-peptide were declining progressively during 1-year follow up. That’s why the diagnosis was changed to DPK A−β−, and lifelong insulinotherapy were prescribed.

Conclusions: Current Aβ classification of DPK is thought to allow to determine necessity of year-long insulinotherapy, which were not proved in our pilot study. The more clinical experience is needed to make strict follow up and treatment recommendations for patients with atypical diabetes.