clinical and biochemical characteristics and treatment outcomes of ketosis-prone diabetes: the remission prone diabetes

Background: diabetic ketoacidosis (dka) is one of the severe acute complications of diabetes. it has long been considered a key clinical characteristic of type 1 diabetes mellitus (t1dm) with severe and irreversible deficient insulin levels. ketosis-prone diabetes (kpd) has pathophysiology close to t2dm but shows signs and symptoms associated with t1dm. in general, patients with ketosisprone diabetes display elevated glucose and ketone levels; also, a higher hemoglobin a1c than conventional t2dm. objectives: the current research aimed to elucidate the clinical presentation and outline a management plan for kpd in the indian population. methods: the present case series is a descriptive, prospective, and observational case series on six unprovoked cases of kpd. they were managed using the standard protocol of dka management. results: the recruited cases followed a set pattern of very high insulin requirement at diagnosis. on follow-up, the insulin requirement progressively declined, and all of the cases were able to stop insulin therapy after a mean period of four weeks. none of the cases presented any organ damage at diagnosis. there was no recurrence of dka during the two-year follow-up. all of the cases had normal liver and renal functions. autoantibodies were negative in all of the cases. conclusions: ketosis-prone diabetes is the most under-recognized and under-diagnosed among all types of diabetes. its recognition is of utmost importance as the approach of its treatment varies widely from that of the conventional type of diabetes. proper follow-up, especially in unprovoked cases of dka with obese phenotype, could help elucidate this rare entity of kpd where insulin can be stopped and maintain normoglycemia for a substantial period without insulin.