Clinical Medicine III.
A. Kovacs1,2, S. Bunduc2, D.S. Veres2,3, D. Palinkas2,4, E.B. Gagyi2, K. Marta2, J.P. Hegyi2, B. Eross2, E. Mihaly1,2, E. Sipter1, P. Panczel1, P. Hegyi2, N. Hosszufalusi1,2
1Department of Internal Medicine and Hematology, Semmelweis University, Budapest, 2Center for Translational Medicine, Semmelweis University, Budapest, 3Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, 4Military Hospital – State Health Centre, Budapest
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.