Ketosis-prone diabetes

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Ketosis-prone diabetes or KPD is an intermediate form of diabetes that has some characteristics of type 1 and some of type 2 diabetes. However, it is distinct from latent autoimmune diabetes, an intermediate diabetes which is known as type 1.5.[1]

KPD is readily diagnosible because it presents a single characteristic, ketoacidosis, which if present, confirms it as ketosis-prone diabetes.[2] KPD comes in four forms depending upon the presence or absence of β-cell autoantibodies (A+ or A−) and β-cell functional reserve (β+ or β−).[3]

Notes

  1. There is clearly a spectrum of clinical phenotypes among patients with islet autoantibodies who do not present with ketosis, including those termed “latent autoimmune diabetes in adults” (LADA) (30), “type 1.5 diabetes” (31,32,33), and “slowly progressing type 1 diabetes” (34). A similar spectrum exists in KPD that includes the very different phenotypes of A+β− and A+β+ KPD. A+β− KPD is synonymous with classic, early onset autoimmune type 1 diabetes; A+β+ KPD may overlap with LADA. However, there are differences between LADA, as recently defined by the Immunology of Diabetes Society, and A+β+ KPD patients; most importantly, the definition of LADA excludes patients who require insulin within the first 6 months after diagnosis, whereas the majority (90%) of A+β+ KPD patients present with DKA as the first manifestation of diabetes and therefore require insulin at the start.

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