A patient with ketosis-prone type 2 diabetes showing nearly normalized glucose tolerance after recovery from severe diabetic ketoacidosis
A patient with ketosis-prone type 2 diabetes showing nearly normalized glucose tolerance after recovery from severe diabetic ketoacidosis
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一名患有酮症倾向的 2 型糖尿病患者在从严重的糖尿病酮症酸中毒恢复后表现出几乎正常的糖耐量
DOI：
10.1007/s13340-022-00599-6
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发表时间：
2022
影响因子：
2.2
通讯作者：
Shimada Akira
中科院分区：
文献类型：
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作者：
Satomura Atsushi;Oikawa Yoichi;Sato Haruhiko;Takagi Sotaro;Yamashita Takuto;Shimada Akira
无诱因的A-β+酮症倾向的2型糖尿病（KPD）的特征在于无促发因素的糖尿病酮症/酮症酸中毒（DK/DKA）的突然发作、阴性抗胰岛自身抗体（“A-“）和使用胰岛素治疗从DKA恢复后β细胞功能的保留（“β+“）。然而，关于恢复后的糖耐量的报道很少。我们报告一例严重糖尿病酮症酸中毒恢复后，葡萄糖耐量几乎正常化的KPD。一名41岁的肥胖女性首次出现无缘无故的严重DKA，即，酮症尿，血糖570 mg/dL，pH 7.18，HCO 3 −5.2 mmol/L，无抗胰岛自身抗体。她在DKA恢复后实现了无胰岛素血糖缓解，导致KPD的诊断。此后，75 g口服葡萄糖耐量试验显示空腹血糖受损，使用间歇扫描连续血糖监测的范围内时间为97%，未用药。这些结果表明，尽管最初有严重的DKA，但一些KPD患者在恢复后可能会达到正常的葡萄糖耐量。DKA的相似发病模式需要适当区分KPD与急性发作的1B型（特发性）糖尿病。
Unprovoked A-β+ ketosis-prone type 2 diabetes (KPD) is characterized by the sudden onset of diabetic ketosis/ketoacidosis (DK/DKA) without precipitating factors, negative anti-islet autoantibodies (“A− ”), and preservation of β-cell function (“β+ ”) after recovery from DKA using insulin therapy. However, there have been few reports on glucose tolerance after recovery. We present a case of KPD with nearly normalized glucose tolerance after recovery from severe DKA. A 41-year-old obese woman first presented with unprovoked severe DKA, i.e., ketonuria, plasma glucose 570 mg/dL, pH 7.18, and HCO3−5.2 mmol/L, without anti-islet autoantibodies. She achieved insulin-free glycemic remission after recovery from DKA, leading to the diagnosis of KPD. Thereafter, 75 g oral glucose tolerance test showed impaired fasting glucose and time-in-range using intermittently scanned continuous glucose monitoring was 97% without medication. These findings suggest that, despite the initial severe DKA, some patients with KPD might achieve normalized glucose tolerance after recovery. The similar onset patterns of DKA necessitates appropriately distinguishing KPD from acute-onset type 1B (idiopathic) diabetes.