Characteristics of Caucasian type 2 diabetic patients during ketoacidosis and at follow-up.
Characteristics of Caucasian type 2 diabetic patients during ketoacidosis and at follow-up.
复制标题
白种人 2 型糖尿病患者酮症酸中毒期间和随访时的特征。
作者：
N. Pitteloud;J. Philippe
目标
分析因糖尿病酮症酸中毒住院的成年白人患者中 2 型糖尿病患者的相对频率及其特征。
研究设计
对 1993 年至 1996 年间出现糖尿病酮症酸中毒的成年患者进行了回顾性研究。典型 1 型糖尿病患者根据发病年龄 < 35 岁、胰岛素依赖性和 BMI < 25 kg/m2 进行分类；不符合这些标准的患者根据基础和刺激的 C 肽以及谷氨酸脱羧酶 (GADA) 和胰岛细胞 (ICA) 抗体的检测进一步分类。
结果
43 例出现糖尿病酮症酸中毒的患者被分为两组，A 组和 B 组。A 组包括 19 例患者，其中 17 例为典型 1 型糖尿病患者，2 例为胰腺切除术后糖尿病患者。其他患者是我们研究的对象（B 组；n = 20，其中 4 例失访）。 13 名患者（B 组 = B I 中的 65%）被诊断为 1 型糖尿病（基础 C 肽中位数：0.15 nmol/l），7 名患者（B 组 = B II 中的 35%）被诊断为 2 型糖尿病（基础 C 肽中位数为 1 nmol/l）。入院时 B I 组和 II 组之间发现较高的体重指数 (BMI)、较短的糖尿病病程、较小的阴离子间隙和较差的血糖控制存在显着差异 (p < 0.05)。中位随访 18 个月后，B II 组患者的代谢控制优于 B I 组，7 名患者中有 5 名未接受胰岛素治疗。
结论
糖尿病酮症酸中毒在 2 型糖尿病患者中比之前认为的更为常见，占所有病例的 16%。就诊时的显着特征是酸中毒程度、糖尿病持续时间、BMI 和 HbA1c。然而，基础血浆 C 肽值仍然是最好的判别因素。
OBJECTIVE
To analyse among adult Caucasian patients hospitalised for diabetic ketoacidosis the relative frequency of patients with type 2 diabetes and their characteristics.
RESEARCH DESIGN
A retrospective review of adult patients presenting with diabetic ketoacidosis was conducted between 1993 and 1996. Patients with typical type 1 diabetes were classified according to age of onset < 35 years, insulin-dependence and BMI < 25 kg/m2; patients who did not meet these criteria were further classified on the basis of a basal and stimulated C-peptide and the detection of antibodies to glutamic acid decarboxylase (GADA) and to islet cells (ICA).
RESULTS
43 patients presenting with an episode of diabetic ketoacidosis were divided into two groups, A and B. Group A consisted of 19 patients, 17 patients classified as patients with typical type 1 diabetes and 2 patients with diabetes post-pancreatectomy. The other patients were the subjects of our study (group B; n = 20, 4 lost to follow-up). 13 patients (65% of group B = B I) were diagnosed with type 1 diabetes (median basal C-peptide: 0.15 nmol/l) and 7 patients (35% of group B = B II) with type 2 diabetes (median basal C-peptide of 1 nmol/l). Higher body mass index (BMI), shorter duration of diabetes, smaller anion gap and worse glycaemic control were found to be significantly different between groups B I and II on admission (p < 0.05). After a median follow-up of 18 months, patients in group B II had a better metabolic control than those in B I and 5 of the 7 patients were treated without insulin.
CONCLUSION
Diabetic ketoacidosis is more common than previously thought in patients with type 2 diabetes, occurring in 16% of all cases. Distinctive features at presentation are the degree of acidosis, the duration of diabetes, BMI and HbA1c. However, the basal plasma C-peptide value remains the best discriminating factor.