Banerji and Dham1 have performed an excellent and thoughtful analysis of our paper on the accuracy and predictive value of the Aβ classification scheme for ketosis-prone diabetes.2
They make the important point that “...it is essential to demonstrate that C-peptide levels measured 2 days after the index DKA predict insulin independence and good glycemic control (and not simply the C-peptide level at 12 months) otherwise the Aβ approach becomes tautological.” In fact we have already demonstrated both these points of clinical utility in earlier publications. The baseline fasting C-peptide level is indeed a strong predictor of good glycemic control.3 We have also found that the rate of achieving insulin independence is predicted by measures of β-cell function; specifically, a higher C-peptide to glucose ratio 6 months after the episode of ketoacidosis is a significant predictor of insulin discontinuation in patients who have preserved β-cell functional reserve at baseline.4
These data indicate that significance of the Aβ classification system for ketosis-prone diabetes extends beyond scientific accuracy to utility and reliability in clinical practice.
References
Banerji MA and Dham S (2007) A comparison of classification schemes for ketosis-prone diabetes. Nat Clin Pract Endocrinol Metab 3: 506–507
Balasubramanyam A et al. (2006) Accuracy and predictive value of classification schemes for ketosis-prone diabetes. Diabetes Care 29: 2575–2579
Maldonado M et al. (2005) Predictors of glycaemic control in indigent patients presenting with diabetic ketoacidosis. Diabetes Obes Metab 7: 282–289
Maldonado MR et al. (2005) Factors associated with insulin discontinuation in subjects with ketosis-prone diabetes but preserved β-cell function. Diabet Med 22: 1744–1750
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Nalini, R., Maldonado, M. & Balasubramanyam, A. A comparison of classification schemes for ketosis-prone diabetes. Nat Rev Endocrinol 3, E1 (2007). https://doi.org/10.1038/ncpendmet0698
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DOI: https://doi.org/10.1038/ncpendmet0698