Clinical characteristics and primary classification for newly diagnosed ketosis-onset diabetes

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Objective To investigate the clinical characteristics and primary classification of newly diagnosed ketosis-onset diabetes. Methods Based on the presence or absence of islet autoantibodies(A+ or A-) and of β-cell functional reserve(β+ or β-), 86 patients with newly diagnosed ketosis-onset diabetes from July 2008 to August 2009 were divided into 4 groups: A+ β-, A+ β+ , A-β- and A-β+ group. Clinical characteristics, including gender, age, presence of metabolic syndrome, body mass index, random blood glucose, glycosylated hemoglobin, β hydroxybutyric acid and C-peptide levels, et al, were compared among the 4 groups. Analysis of variance was used for statistic analysis. Results There were 15 cases in A+ β- group(17.4%, male 9, female 6), 5 cases in group A+ β+ (5.8%, male 3, female 2), 27 cases in group A-β-(31.4%, male 20, female 7) and 39 cases in group A-β+ (45.4%, male 26, female 13), respectively.Group A+ β- had obviously lower age, body mass index, waist circumference and carbon dioxide combining power than those in group A+ β+ , A-β- and A-β+ (age: (24±12) vs (44±13), (43±13) and (54±17) years, respectively, all P<0.05; body mass index: (18±3) vs (22±3), (22±3) and (24±4) kg/m2, respectively, all P<0.05; waist circumference: (69±12) vs (82±5), (81±9) and (86±10) cm, respectively, all P<0.05; carbon dioxide combining power: (12±7) vs (20±4), (19±7) and (21±4) mmol/L, respectively, all P<0.05). Random blood glucose and β hydroxybutyric acid levels in group A+ β- were obviously higher than those in group A+ β+ , A-β- and A-β+ (random blood glucose: (32±9) vs (19±3), (25±9) and (23±6)mmol/L, respectively, all P<0.05; β hydroxybutyric acid: 4.80(1.74-14.03) vs 0.79(0.41-3.37), 1.34(0.33-15.75) and 0.80(0.31-8.27) mmol/L, respectively, all P<0.05). Group A-β- had obviously lower age and body mass index than those in group A-β+ (all P<0.05). Group A-β+ had obviously higher proportion(48.7%) of metabolic syndrome than those in group A+ β-(6.7%) and group A-β-(22.2%)(both P<0.05). The levels of fasting C-peptide, postprandial C-peptide in A+ β- and A-β- group were obviously lower than those in group A+ β+ and A-β+ (fasting C-peptide: 0.25(0.18-0.39), 0.30(0.03-0.63), 0.87(0.62-1.18) and 1.16(0.75-3.46) μg/L, respectively, all P<0.01; postprandial C-peptide: 0.56(0.21-2.02), 1.00(0.25-1.94), 3.45(1.73-3.84) and 2.28 (1.14-13.79) μg/L, respectively, all P<0.01). Conclusions The patients in the A+ β-, A+ β+ , A-β- and A-β+ groups may be assigned to autoimmune type 1 diabetes mellitus, latent autoimmune diabetes in adults, idiopathic type 1 diabetes mellitus and type 2 diabetes mellitus, respectively. Key words: Diabetes mellitus; Ketosis; Classification