Endocrine Abstracts

Background: Ketosis-prone diabetes (KPD) is an uncommon form of diabetes characterised by presentation with diabetic ketoacidosis (DKA) or ketosis in the absence of autoimmune type 1 diabetes, with potential for subsequent insulin independence. While more prevalent in African, Hispanic, and Asian populations, its occurrence in Caucasians is poorly documented.

Objective: To describe the presentation, classification, and clinical course of five Caucasian patients with KPD using the Aβ classification system.

Methods: A retrospective review identified adults presenting with DKA or ketosis between 2022 and 2024. C-peptide and islet autoantibody testing (anti-GAD, IA2, ZnT8 where available) determined Aβ status. Clinical parameters, treatment regimens, and time to insulin cessation were recorded.

Results: All five patients were classified as A−B+, indicating absent autoimmunity and preserved beta-cell function. All initially received basal-bolus insulin, later discontinued in favour of oral hypoglycemic agents or GLP-1 receptor agonists within weeks to months. Insulin cessation was prompted by hypoglycemia, improved glycemic control, and confirmatory phenotyping. Misclassification as type 1 diabetes occurred in all cases prior to antibody and C-peptide testing.

Conclusion: KPD occurs in the Irish Caucasian population but is likely under-recognized due to diagnostic bias and lack of routine phenotyping. Early measurement of C-peptide and islet antibodies in adults presenting with DKA or ketosis enables accurate diagnosis, optimizes therapy, and prevents unnecessary long-term insulin use. Prospective studies are warranted to better define the prevalence, natural history, and optimal management of KPD in Caucasian populations.