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Ketosis-Prone Type 2 Diabetes in Patients of Sub-Saharan African Origin
Open accessAbstract
Nonautoimmune ketosis-prone diabetic syndromes are increasingly frequent in nonwhite populations. We have characterized a cohort of patients of sub-Saharan African origin who had ketosis-prone type 2 diabetes (n = 111), type 1 diabetes (n = 21), and type 2 diabetes (n = 88) and were admitted to a hospital for management of uncontrolled diabetes. We compared epidemiological, clinical, and metabolic features at diabetes onset and measured insulin secretion (glucagon-stimulated C-peptide) and insulin action (short intravenous insulin tolerance test) during a 10-year follow-up. Ketosis-prone type 2 diabetes shows a strong male predominance, stronger family history, higher age and BMI, and more severe metabolic decompensation than type 1 diabetes. In ketosis-prone type 2 diabetes, discontinuation of insulin therapy with development of remission of insulin dependence is achieved in 76% of patients (non–insulin dependent), whereas only 24% of patients remain insulin dependent. During evolution, ketosis-prone type 2 diabetes exhibit specific β-cell dysfunction features that distinguish it from type 1 and type 2 diabetes. The clinical course of non–insulin-dependent ketosis-prone type 2 diabetes is characterized by ketotic relapses followed or not by a new remission. Progressive hyperglycemia precedes and is a strong risk factor for ketotic relapses (hazard ratio 38). The probability for non–insulin-dependent ketosis-prone type 2 diabetes to relapse is 90% within 10 years, of whom ∼50% will become definitively insulin dependent. Insulin sensitivity is decreased in equal proportion in both ketosis-prone type 2 diabetes and type 2 diabetes, but improves significantly in non–insulin-dependent ketosis-prone type 2 diabetes, only after correction of hyperglycemia. In conclusion, ketosis-prone type 2 diabetes can be distinguished from type 1 diabetes and classical type 2 diabetes by specific features of clinical pathophysiology and also by the natural history of β-cell dysfunction and insulin resistance reflecting a propensity to glucose toxicity.
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“In ketosis-prone diabetes, women are protected unless they are in a hypoestrogenic state [43, 45].”
From Sex differences in metabolic homeostasis, diabetes, and obesity (2015) · cites this paper as [43]
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“A strong male predominance (75 %) is also observed in ketosis-prone diabetes (also called idiopathic diabetes), a form of type 2 diabetes with a propensity to acute insulin deficiency [43, 44].”
From Sex differences in metabolic homeostasis, diabetes, and obesity (2015) · cites this paper as [43]
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Citations
Cites
Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus
The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus* (2002) · Diabetes Care · doi:10.2337/diacare.25.2007.s5 · Cited by 10,325
Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus
The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (1997) · Diabetes Care · doi:10.2337/diacare.20.7.1183 · Cited by 6,220
Cellular mechanisms of insulin resistance
Shulman, G. I. (2000) · Journal of Clinical Investigation · doi:10.1172/jci10583 · Cited by 2,714
Eisenbarth (1986) · doi:10.1056/nejm198605223142106 · Cited by 1,659
Evans, J. L., Goldfine, I. D., Maddux, B. A., & Grodsky, G. M. (2003) · Diabetes · doi:10.2337/diabetes.52.1.1 · Cited by 1,482
McGarry, J. D. (2002) · Diabetes · doi:10.2337/diabetes.51.1.7 · Cited by 1,435
Increased incidence of non-insulin-dependent diabetes mellitus among adolescents
Pinhas‐Hamiel, O., Dolan, L. M., Daniels, S. R., Standiford, D. A., Khoury, P. R., & Zeitler, P. S. (1996) · The Journal of Pediatrics · doi:10.1016/s0022-3476(96)80124-7 · Cited by 1,169
Poitout, V., & Robertson, R. P. (2002) · Endocrinology · doi:10.1210/endo.143.2.8623 · Cited by 743
Polonsky, K. S., Sturis, J., & Bell, G. I. (1996) · New England Journal of Medicine · doi:10.1056/nejm199603213341207 · Cited by 595
Beta-cell adaptation and decompensation during the progression of diabetes
Weir, G. C., Laybutt, D. R., Kaneto, H., Bonner-Weir, S., & Sharma, A. (2001) · Diabetes · doi:10.2337/diabetes.50.2007.s154 · Cited by 462
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Hyperglycemic crises in adult patients with diabetes
Kitabchi, A. E., Umpierrez, G. E., Miles, J. M., & Fisher, J. N. (2009) · Diabetes Care · doi:10.2337/dc09-9032 · Cited by 2,062
Diabetes in sub-Saharan Africa
Mbanya, J. C., Motala, A. A., Sobngwi, E., Assah, F. K., & Enoru, S. T. (2010) · The Lancet · doi:10.1016/s0140-6736(10)60550-8 · Cited by 805
Self-citationSex differences in metabolic homeostasis, diabetes, and obesity
Mauvais-Jarvis, F. (2015) · Biology of Sex Differences · doi:10.1186/s13293-015-0033-y · Cited by 626
“In ketosis-prone diabetes, women are protected unless they are in a hypoestrogenic state [43, 45].”
BackgroundSelf-citationThe many faces of diabetes: a disease with increasing heterogeneity
Tuomilehto, J., Santoro, N., Caprio, S., Cai, M., Weng, J., & Groop, L. (2013) · The Lancet · doi:10.1016/s0140-6736(13)62219-9 · Cited by 669
Antar, S. A., Ashour, N. A., Sharaky, M. M., Khattab, M., Ashour, N. A., Zaid, R. T., Roh, E. J., Elkamhawy, A., & Al-Karmalawy, A. A. (2023) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2023.115734 · Cited by 812
Metadata
- Authors
- Mauvais-Jarvis, F., Sobngwi, E., Porcher, R., Riveline, J.-P., Kevorkian, J.-P., Vaisse, C., Charpentier, G., Guillausseau, P.-J., Vexiau, P., & Gautier, J.-F.
- Affiliations
- Department of Endocrinology & Diabetes, Saint-Louis Hospital and University of Paris VII School of Medicine, Paris, France
- Department of Medical Biostatistics, Saint-Louis Hospital and University of Paris VII School of Medicine, Paris, France
- Centre Hospitalier Sud Francilien (FR)
- Department of Internal Medicine B, Lariboisiere Hospital, Paris, France
- University of California, San Francisco (US)
- Hôpital Lariboisière (FR)
- Université Paris Cité (FR)
- Venue
- Diabetes
- Publisher
- American Diabetes Association
- Published
- 2004-03-01
- Volume
- 53
- Issue
- 3
- Pages
- 645-653
- ISSN
- 0012-1797 (ISSN-L)
- 1939-327X
- OpenAlex
- W2137508233
- Cited by
- 294
- References
- 39
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 12 · 2023: 15 · 2022: 23 · 2021: 16 · 2020: 12 · 2019: 14 · 2018: 19 · 2017: 9 · 2016: 13 · 2015: 22 · 2014: 18 · 2013: 17 · 2012: 13
- FWCI
- 4.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pancreatic function and diabetes
- Keywords
- ketosis-prone type 2 diabetes, type 1 diabetes, beta-cell dysfunction, insulin resistance, insulin dependence, remission, hyperglycemia, glucotoxicity, insulin secretion, insulin tolerance test, C-peptide
- MeSH terms
- Insulin Secretion, Adult, Blood Glucose, Diabetes Mellitus, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Humans, Insulin, Insulin Antibodies, Insulin Resistance, Islets of Langerhans, Obesity, Cohort Studies, Body Mass Index, Africa South of the Sahara
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