Clinical and laboratory features of ketosis-prone diabetes5,25,27
| Clinical considerations | Laboratory features |
|---|---|
| Unprovoked ketoacidosis often occurs; may be new-onset diabetes | β-cell antibodies present in up to 28% of patients25 |
| Afro-Caribbean or Hispanic ancestry | C-peptide often low or undetectable during diabetic ketoacidosis; recovery expected in > 60% |
| Periods of insulin independence interspersed with periods of acute insulin deficiency and diabetic ketoacidosis | Ratio of fasting C-peptide (nmol/L) to glucose (mmol/L) > 11 may be used as reliable predictor of insulin discontinuation27 |
| Type 2 diabetes phenotype common (obesity, insulin resistance, metabolic syndrome) | Presence of HLA alleles for type 1 diabetes associated with insulin dependence within 1–2 yr25 |
| Fluctuating glycated hemoglobin (A1C) pattern consistent with β-cell failure and recovery | |
| Male predominance among patients with unprovoked diabetic ketoacidosis (male–female ratio 2.6:1)5 | |
| Insulin should always be initial therapy, with reduction of cardiovascular risk factors5 |
Note: HLA = human leukocyte antigen.