Presence of the metabolic syndrome distinguishes patients with ketosis-prone diabetes who have a Type 2 diabetic phenotype.

OBJECTIVE

This study was designed to determine if patients with ketosis-prone diabetes could be distinguished clinically on the basis of features of the metabolic syndrome (MetS).

METHODS

Participants with ketosis-prone diabetes admitted to our institution during a 3-year period were studied. One hundred seventy-two patients from four ethnic backgrounds were divided into two groups: with or without MetS, as defined by the World Health Organization. Pearson's chi-square test or one-way ANOVA was used as appropriate to evaluate group differences.

RESULTS

Of the 172 patients, 74 (43%) had at least three characteristics of MetS (+MetS group), while 98 (57%) had less than three characteristics of MetS (-MetS group). The +MetS group had significantly higher beta-cell functional reserve as measured by the glucagon stimulation test [area under the curve (AUC) for C-peptide levels 19.50+/-2.26 compared with 8.66+/-1.66 ng/ml over 10 min; P=.0001]. A significantly higher proportion of patients in the +MetS group had preserved beta-cell functional reserve than in the -MetS group (70% compared with 30%; P<.00001). After 12 months of follow-up, +MetS patients had significantly lower HbA1c levels (8.3+/-0.4% compared with 9.8+/-0.4%; P=.01) and higher C-peptide/glucose ratios (2.01+/-0.28 compared with 1.14+/-0.21; P=.02) than the -MetS patients did.

CONCLUSIONS

Patients with ketosis-prone diabetes with the MetS are more likely to have features associated with Type 2 diabetes, despite having developed diabetic ketoacidosis (DKA), with better beta-cell functional reserve and glycemic control after the index DKA episode.