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World J Clin Cases. Oct 26, 2022; 10(30): 10867-10872
Published online Oct 26, 2022. doi: 10.12998/wjcc.v10.i30.10867
Ketosis-prone diabetes mellitus: A phenotype that hospitalists need to understand
Sydney Boike, Mikael Mir, Ibtisam Rauf, Abbas B Jama, Shaleen Sunesara, Hisham Mushtaq, Anwar Khedr, Jain Nitesh, Salim Surani, Syed A Khan
Sydney Boike, Mikael Mir, Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, United States
Ibtisam Rauf, Medicine, St. George’s School of Medicine, Grenada FZ818, West Indies
Abbas B Jama, Jain Nitesh, Syed A Khan, Critical Care Medicine, Mayo Clinic Health System, Mankato, MN 56001, United States
Shaleen Sunesara, Medicine, University of Southern California, Los Angeles, CA 90007, United States
Hisham Mushtaq, Medicine, St. Vincent’s Medical Center, Bridgeport, CT 06606, United States
Anwar Khedr, Medicine, BronxCare Health System, Bronx, NY 10457, United States
Salim Surani, Medicine, Texas A&M University, Bryan, TX 77843, United States
Salim Surani, Anesthesiology, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Boike S, Mir M, Rauf I, and Jama AB contributed to conceptualization, drafting, reviewing, final editing, and agreeing to the accuracy of the work; Mushtaq H, Khedr A, and Nitesh J contributed to literature search and review of the manuscript; Surani S and Khan SA contributed to supervision, critical revision of the manuscript, editing, reviewing, and agreeing to the final accuracy of the work.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Salim Surani, FCCP, MD, MS, Professor, Medicine, Texas A&M University, College Station, Bryan, TX 77843, United States. srsurani@hotmail.com
Received: July 20, 2022
Peer-review started: July 20, 2022
First decision: August 7, 2022
Revised: August 23, 2022
Accepted: September 9, 2022
Article in press: September 9, 2022
Published online: October 26, 2022
Processing time: 92 Days and 21.8 Hours
Abstract

Diabetes has been classified mainly into types 1 and 2. Some type 2 diabetes patients, when developing ketosis, have been labeled as having atypical diabetes. Lately, syndromes of ketosis-prone diabetes, primarily in patients who we previously classified as type 2 diabetics, have emerged, and calls are being made to even reclassify diabetes. This mini-review will extensively deal with the historical, molecular, phenotypical, and clinical basis of why ketosis-prone diabetes is different than the traditional principles of type 1 and 2 diabetes and should be classified as such. Clinicians, especially those who are not diabetologists or endocrinologists, as well as hospitalists, intensivists, and primary care providers, will greatly benefit from this review.

Keywords: Diabetic ketoacidosis; Diabetes; Diabetes prone ketosis; Ketosis; Acidosis

Core Tip: Diabetes is one of the most common chronic diseases globally. Ketosis-prone diabetes is now being increasingly recognized. The majority of patients with ketosis-prone diabetes are being diagnosed at the time of their presentation as diabetic ketoacidosis. Its presentation is unique, and it has components of both type 1 and type 2 diabetes. This article helps the clinician understand the pathophysiology of this phenotype.