Objective: To study the clinical characteristics and natural history of adult diabetic patients with ketosis as the initial manifestation.
Methods: In 60 patients with ketosis as the initial symptom, the mean age was (42.78+/-11.14) years and body mass index(BMI) was (2.34+/-3.47) kg/m2. The islet cell antibody (ICA), anti-glutamic acid decarboxylase (GAD) antibody, fast plasma glucose and insulin level, glucose and insulin level of 2 hours after oral glucose test were measured. After insulin therapy, these patients received therapy plan according to their glucose level. During follow-up period, these items were tested again.
Results: There were 27 patients using insulin and 33 patients using diet or oral hypoglycemic drugs for controlling blood glucose during the follow-up. Compared with patients using insulin therapy, patients using oral hypoglycemic drugs or diet therapy showed higher BMI (at onset of ketosis (25.69+/-2.66) kg/m2 vs. (22.64+/-3.75) kg/m2, P=0.001; during follow-up period (26.19+/-3.11) kg/m2 vs. (22.29+/-2.97) kg/m2, P=0.000), higher post-load serum insulin level (at onset of ketosis (32.39+/-35.87) mU/L vs. (18.53+/-14.43) mU/L, P=0.017; during follow-up period (67.34+/-68.42) mU/L vs. (36.40+/-45.39) mU/L, P=0.004), lower HbA 1C (at onset of ketosis (10.76+/-1.25) percent vs. (12.04+/-1.99) percent, P=0.006; during follow-up period (6.97+/-1.31)percent vs. (9.36+/-3.18) percent, P=0.000), higher percentage of ICA and GAD positivity (at onset of ketosis, ICA positive rate was 18.52 percent vs. 0, P=0.030, GAD positive rate was 18.52 percent vs. 0, P=0.030; during follow-up period, ICA positive rate was 7.41 percent vs. 0, P=0.111, GAD positive rate was 14.81 percent vs. 0, P=0.022).
Conclusion: Among the adult diabetic patients with ketosis as the first symptom, quite a number of patients are not insulin dependent for the long-term blood sugar control. Ketosis is not a good index for differentiating type 1 from type 2 diabetes.