Ketosis Prone Diabetes in African-Americans

More than half of obese African-Americans (AA) with newly diagnosed diabetes presenting with diabetic ketoacidosis (DKA) display clinical, metabolic, and immunogenetic features of type 2 diabetes during follow-up. Prior studies by our group and other investigators indicate that, at presentation, these patients a) have markedly decreased insulin secretion and impaired insulin action, b) have low prevalence of positive B-cell autoantibodies, and c) respond to aggressive diabetic management with significant improvement in B-cell function and insulin sensitivity sufficient to allow discontinuation of insulin therapy. Upon discontinuation of insulin, the period of near-normoglycemia remission (defined as the ability to discontinue insulin injections for ≥ one week and remain in good metabolic control - fasting blood glucose ≤ 120 mg/dl and A1c ≤ 7%) may last for a few months to several years. These patients are referred to as having atypical diabetes, Flatbush diabetes, or ketosis-prone type 2 diabetes (KPDM). Patients with "KPDM" are therefore an ideal model to follow throughout their clinical course in order to correlate their response to treatment with the mechanism(s) and markers of short- and long-term remission and determine the optimal therapeutic approach in order to prevent future glycemic decompensation.

Inclusion criteria

• 36 Obese AA subjects with DKA or severe hyperglycemia and 8 obese nondiabetic subjects, age 19-65. All studies will be performed in the GCRC at Grady Memorial Hospital.
• Subjects with a BMI ≥ 28 kg/m2 will be included.
• Diagnostic criteria for DKA will include:

• a plasma glucose > 250 mg/dl,
• a venous pH < 7.30,
• a serum bicarbonate < 18 mEq/l, and
• high serum ketones.
• Obese hyperglycemic patients will have:

• a blood glucose on admission > 400 mg/dl,
• a serum bicarbonate > 18 mEq/l, and
• negative ketones.

Exclusion criteria

• Patients with significant medical or surgical illness, including but not limited to myocardial ischemia, congestive heart failure, chronic renal insufficiency, liver failure, and infectious processes;
• Patients with recognized endocrine disorders, such as hypercortisolism, acromegaly, or hyperthyroidism;
• Bleeding disorders, or abnormalities in coagulation studies;
• Pregnancy.