Читать книгу Clinical Dilemmas in Diabetes - Группа авторов - Страница 60

Atypical diabetes or “ketosis‐prone type 2 diabetes” were monikers used to describe obese minority (typically African‐American) patients presenting with diabetic ketoacidosis as their first manifestation of diabetes [44]. Typically, after acute metabolic control is achieved, such patients are able to maintain glycemic control over long periods of time without insulin (often with diet alone). The concept of glucose toxicity where hyperglycemia per se impairs insulin secretion and action has been put forward to explain these observations [45]. Indeed, during recovery, these indices do not differ from those of age‐ and weight‐matched controls [46]. Similar short‐term exposure to lipotoxicity also has little effect on β‐cell function [47].

Short‐term intensive insulin therapy in a cohort of Chinese patients with a first presentation of diabetes produced a “remission” of diabetes with preservation of insulin secretion at one year when compared to conventionally treated patients [48]. Diabetes remission, independent of weight‐loss, is also reported after bariatric surgery but – at least in the short‐term is likely explained by caloric restriction and β‐cell “rest” [49]. This is in keeping with the concept that insulin over‐production may produce endoplasmic reticulum stress and if unchecked lead to β‐cell death [50].

These factors probably explain the resumption of endogenous insulin secretion and decreased or absent exogenous insulin requirements during the honeymoon period in type 1 diabetes. The term refers to a variable interval after presentation with hyperglycemia and subsequent restoration of metabolic and glycemic control. Some patients have a prolonged remission and indeed tight glycemic control seems to prolong the persistence of endogenous insulin secretion in affected patients.