Ketosis-prone type 2 diabetes in Caucasian adults: a follow-up cohort analysis

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Aim To assess the prevalence, baseline features, and long-term clinical course of ketosis-prone type 2 diabetes in adult Caucasians presenting with new-onset diabetic ketoacidosis or ketosis. Methods Clinical data were retrospectively retrieved from electronic medical records, with longitudinal follow-up available. Participants were classified as type 1, latent autoimmune diabetes of adults, ketosis-prone type 2, or non-ketotic type 2 diabetes according to ketosis status, diabetes-related autoantibodies, and fasting C-peptide (within the reference range for ketosis-prone type 2 diabetes). Descriptive statistics and regression models were applied to compare clinical characteristics across diabetes groups. Results Of 183 newly diagnosed patients, 86 presented with ketosis, including 22 with ketosis-prone type 2 diabetes. Compared with those with type 1 diabetes, these individuals were older (mean±SD; 54.9±12.6 vs. 34.8±12.6 years, p<0.0001), had higher body mass index (31.5±5.6 kg/m 2 vs. 22.5±3.7 kg/m 2 , p<0.0001), higher glycated hemoglobin (13.3±3.1% vs. 10.8±3.2%, p=0.0047), and greater hepatic steatosis (hepatic steatosis index: 45.4±6.2 vs. 34.7±4.7, p<0.0001). In ketosis-prone type 2 diabetes, beta-cell function remained preserved long after the index episode (5-10 years: 4.37±2.45 ng/mL; 10-15 years: 2.85±1.54 ng/mL). Conclusion One-fourth of adult Caucasian patients with new-onset diabetic ketosis had ketosis-prone type 2 diabetes, characterised by negative autoantibodies, preserved C-peptide, and sustained long-term endogenous insulin secretion.