PhD Scientific Days 2022

Clinical Medicine III.

One in three new onset diabetic ketosis in adults is not associated with type 1 diabetes: a meta-analysis

Text of the abstract

Introduction and aims: Ketosis-prone type 2 diabetes mellitus (KPT2D) has been previously described in the literature. Nevertheless, only since 2019 was it defined by the World Health Organization as a hybrid form of diabetes characterized by unprovoked ketosis onset with preserved insulin secretion and the absence of diabetes-related autoantibodies. It mainly affects non-Caucasian patients but the exact prevalence is unknown. Insulin treatment, although necessary at onset, may be waived in some of the KPT2D cases during disease course. We conducted a systematic review and meta-analysis to assess the prevalence and to describe the clinical characteristics of KPT2D among patients presenting with diabetic ketosis at diabetes onset.
Methods: The systematic search was performed in five databases - MEDLINE, Embase, Web of Science, Scopus and CENTRAL, without any filters. For eligibility assessment we used the following definition of KPT2D (exposed group): newly diagnosed autoantibody-negative diabetic ketosis cases with preserved beta cell function (C-peptide in the given reference range). Since ketosis onset is usually associated with type 1 diabetes (T1D), the comparator group comprised patients with T1D presenting with ketoacidosis or ketosis. A random effects model was used in meta-analysis to calculate the pooled prevalence, odds ratios (ORs), mean differences (MDs) and the 95% confidence intervals (CIs). The I2 value assessed statistical heterogeneity.
Results: Out of 16.962 articles 11 were eligible, counting 2010 patients. Among patients presenting with diabetic ketosis at diabetes onset 35% (95% CI: 0.24–0.49; I2=94%, 95% CI: 91–96%) belonged to the KPT2D group. Patients with KPT2D were older (MD=11.55 years, 95% CI: 5.5–17.6; I2=88%, 95% CI: 79–93%) and had a significantly higher BMI (MD=5.48 kg/m2, 95% CI: 3.25–7.72; I2=92%, 95% CI: 86–95%) compared to patients with T1D. HbA1c level at admission, gender distribution, and family history of diabetes did not differ significantly between the two groups.
Conclusion: Ketosis-prone type 2 diabetes is a common type of diabetes among adult patients with diabetic ketosis. Testing for C-peptide and islet cell autoantibodies in all newly diagnosed patients with diabetic ketoacidosis or ketosis at onset is essential for a proper classification and will allow an adequate long-term treatment.