Ketosis‐prone atypical diabetes in Cameroonian people with hyperglycaemic crisis: frequency, clinical and metabolic phenotypes

• Published in: Diabetic medicine 2017-03, Vol.34 (3), p.426-431
• Main Authors: Lontchi‐Yimagou, E., Nguewa, J. L., Assah, F., Noubiap, J. J., Boudou, P., Djahmeni, E., Balti, E. V., Atogho‐Tiedeu, B., Gautier, J. F., Mbanya, J. C., Sobngwi, E.
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Aged; Cameroon; Combined Modality Therapy; Cross-Sectional Studies; Diabetes; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - ethnology; Diabetes Mellitus, Type 2 - metabolism; Diabetes Mellitus, Type 2 - therapy; Diabetic Ketoacidosis - diagnosis; Diabetic Ketoacidosis - ethnology; Diabetic Ketoacidosis - metabolism; Diabetic Ketoacidosis - therapy; Diagnosis, Differential; Female; Glucose; Glycated Hemoglobin A - analysis; Hospitals, Urban; Humans; Hyperglycemia - prevention & control; Insulin - blood; Insulin - metabolism; Insulin resistance; Insulin Resistance - ethnology; Insulin Secretion; Insulin-Secreting Cells - metabolism; Lipids; Male; Metabolism; Middle Aged; Referral and Consultation
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.13264

Aim It is unclear whether ketosis‐prone diabetes is a specific type or a subtype of Type 2 diabetes. We aimed to describe the clinical and metabolic features of ketosis‐prone diabetes in a sub‐Saharan population. Methods We consecutively enrolled and characterized 173 people with non‐autoimmune diabetes admitted for hyperglycaemic crisis at the Yaoundé Central Hospital, Cameroon. Blood samples were collected for fasting glucose, HbA1c, lipid profile and C‐peptide assays with insulin resistance and secretion estimation by homeostasis model assessment. People were classified as having Type 2 diabetes (n = 124) or ketosis‐prone diabetes (n = 49). Ketosis‐prone diabetes was sub‐classified as new‐onset ketotic phase (n = 34) or non‐ketotic phase (n = 15). Results Ketosis‐prone diabetes was found in 28.3% of the hyperglycaemic crises. Age at diabetes diagnosis was comparable in Type 2 and ketosis‐prone diabetes [48 ± 14 vs 47 ± 11 years; P = 0.13] with a similar sex distribution. Overall BMI was 27.7 ± 13.4 kg/m2 and was ≥ 25 kg/m2 in 55.8% of those taking part, however, 73.5% of those with ketosis‐prone diabetes reported weight loss of > 5% at diagnosis. Blood pressure and lipid profile were comparable in both types. Ketosis‐prone diabetes in the ketotic phase was characterized by lower insulin secretion and higher serum triglycerides compared with non‐ketotic ketosis prone and Type 2 diabetes. Type 2 and ketosis prone diabetes in the non‐ketotic phase were comparable in terms of lipid profile, blood pressure, waist‐to‐hip ratio, BMI and fat mass, insulin secretion and insulin resistance indices. Conclusions Ketosis‐prone diabetes is likely to be a subtype of Type 2 diabetes with the potential to develop acute insulinopenic episodes. What's new? Although ketosis‐prone diabetes has been described in many populations, there are few reports in sub‐Saharan populations living in Africa. This article presents some epidemiological, clinical and metabolic features of ketosis‐prone diabetes in Cameroon. Ketosis‐prone diabetes may be more frequent than expected in sub‐Saharan Africa and is comparable with Type 2 diabetes, with the exception of acute ketotic onset and relapses and transient lower insulin secretion. Ketosis‐prone diabetes is likely to be a subtype of Type 2 diabetes with the potential to develop acute insulinopenic phases at diagnosis or during unexplained ketotic relapses.