Diabetes in African Americans - M C Marshall Jr
Atypical diabetes may constitute 10% of African American diabetic youth and is
quite similar to the atypical diabetes in African American adults (vida infra). Unlike classic type 1 diabetes or MODY, 50% of African American youth with atypical diabetes are obese. Also unlike type 1 diabetes, these patients lack islet cell autoantibodies and have a subsequent clinical course that is similar to type 2 diabetes. However, unlike typical type 2 diabetes, atypical diabetes generally presents acutely, often with weight loss and ketosis.
ATYPICAL DIABETES
A review of diabetes in the African American community would not be complete without a discussion of the ‘‘atypical’’ diabetes that has been described in this population. African Americans with type 2 diabetes have been found to have two distinctive atypical features. The first is that adult African American diabetics may present with classic signs and symptoms of DKA and thus look like type 1 diabetic patients. However, unlike type 1 diabetic patients:
(1) these patients have no autoimmune markers of type 1 diabetes;
(2) they are often obese;
(3) there is evidence of insulin resistance; and
(4) most importantly, after intensive therapy, spontaneous remission is the rule, with restoration of b cell
function within months and maintenance of normoglycaemia with oral agents or only dietary treatment.
These patients have impaired insulin secretion when admitted with DKA, but their subsequent clinical course is typical of type 2 diabetes. Recurrence of DKA is infrequent. Among those patients who remain insulin-requiring, recurrence of DKA is most often caused by non-compliance with insulin therapy. The other unique feature of diabetes in African Americans is that spontaneous remission is also seen among patients who are not ketotic. When adult African Americans with newly diagnosed type 2 diabetes receive an average of three months of intensive, multidisciplinary therapy, 30%–40% of these patients will go into remission—that is, they will achieve normoglycaemia without pharmacological therapy. Those who remit have a significantly greater return of b cell function. However, there are no clinical characteristics that can differentiate those who will remit from those who will not. There is evidence that these atypical features are also present in African American children and adolescents with type 2 diabetes. It bears remembering that the African American diabetic patient who is initially controlled with insulin need not necessarily remain on insulin therapy, and the African American diabetic patient who is initially controlled with oral agents need not necessarily remain on pharmacological therapy.
(1) these patients have no autoimmune markers of type 1 diabetes;
(2) they are often obese;
(3) there is evidence of insulin resistance; and
(4) most importantly, after intensive therapy, spontaneous remission is the rule, with restoration of b cell
function within months and maintenance of normoglycaemia with oral agents or only dietary treatment.
These patients have impaired insulin secretion when admitted with DKA, but their subsequent clinical course is typical of type 2 diabetes. Recurrence of DKA is infrequent. Among those patients who remain insulin-requiring, recurrence of DKA is most often caused by non-compliance with insulin therapy. The other unique feature of diabetes in African Americans is that spontaneous remission is also seen among patients who are not ketotic. When adult African Americans with newly diagnosed type 2 diabetes receive an average of three months of intensive, multidisciplinary therapy, 30%–40% of these patients will go into remission—that is, they will achieve normoglycaemia without pharmacological therapy. Those who remit have a significantly greater return of b cell function. However, there are no clinical characteristics that can differentiate those who will remit from those who will not. There is evidence that these atypical features are also present in African American children and adolescents with type 2 diabetes. It bears remembering that the African American diabetic patient who is initially controlled with insulin need not necessarily remain on insulin therapy, and the African American diabetic patient who is initially controlled with oral agents need not necessarily remain on pharmacological therapy.
Mike
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