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Abstract
Ketosis-prone diabetes mellitus (KPD), which is an atypical type of diabetic mellitus with severe β cell dysfunction, is accompanied by ketosis or ketoacidosis without specific preceding factors at diagnosis. KPD shows mixed features of type 1 and type 2 diabetes. In some cases, the recovery of the function of β cells during intensified diabetic management enabled the termination of insulin therapy. The Aβ classification system classifies KPD patients into four distinct subgroups depending upon the presence or absence of β cell autoimmunity and β cell functional reserve and has been recognized as an important tool to predict clinical outcomes. In Korea, several cases of KPD with absence of β cell autoimmunity have been reported. A 60-year-old man presenting with DKA (diabetic ketoacidosis) as the first manifestation of diabetes, was shown to have β cell autoimmunity. A significant improvement in glycemic control was shown as a result of aggressive diabetic management; shortly after an acute episode of DKA, the recovery of β cell functional reserve was confirmed. This result allowed discontinuation of insulin therapy and maintenance of euglycemic status without antidiabetic medication.
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Table 1.
Baseline clinical characteristics of subjec cts (n = 45)
| Variable | On admission | On discharge (45 days after admission) |
|---|---|---|
| Random plasma glucose (mg/dL) | 1440 | 156 |
| C-peptide (ng/mL) | 0.58 | |
| HbA1C (%) | 16.1 | 7.0 |
| Glycoalbumin (%) | 65 | 18.0 |
| GAD antibody (U/mL) | 53.08 | 28.16 |
| Islet cell antibody | Negative | |
| Serum osmolarity (mOsm/kg) | 437 | |
| Urine osmolarity (mOsm/kg) | 445 | |
| Urine ketone | 1+ | |
| Serum Na (mmol/L) | 145 | 144 |
| Serum K (mmol/L) | 2.4 | 3.7 |
| Serum Cl (mmol/L) | 109 | 116 |
| ABGAa | ||
| pH | 7.213 | |
| pCO2 (mm Hg) | 21.4 | |
| pO2 (mm Hg) | 318.3 | |
| ‒ (mmol/L) HCO3 | 8.7 | |
| 3 Base excess (mmol/L) | –19.3 | |
| BUN (mg/dL) | 82.7 | 8.6 |
| Cr (mg/dL) | 7.53 | 1.43 |
| Fasting plasma glucose (mg/dL) | 96 | |
| 2-hour postprandial plasma glucose (mg/dL) | 135 | |
| Fasting C-peptide (ng/mL) | 2.12 | |
| 2-hour postprandial C-peptide (ng/mL) | 3.89 | |
| Fasting insulin (μU/mL) | 4.34 | |
| 2-hour postprandial insulin (μU/mL) | 11.66 | |
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