A comparison of classification schemes for ketosis-prone diabetes
Ramaswami Nalini*, Mario Maldonado and Ashok Balasubramanyam About the authors
Correspondence *Division of Diabetes, Endocrinology and Metabolism, N520 Alkek, One Baylor Plaza, Baylor College of Medicine, Houston, TX 77030, USA
Email nalini@bcm.edu
Banerji and Dham1 have performed an excellent and thoughtful analysis of our paper on the accuracy and predictive value of the A
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 A 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 -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 -cell functional reserve at baseline.4
These data indicate that significance of the A 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 | Article | PubMed |
- Balasubramanyam A et al. (2006) Accuracy and predictive value of classification schemes for ketosis-prone diabetes. Diabetes Care 29: 2575–2579 | Article | PubMed | ISI | ChemPort |
- Maldonado M et al. (2005) Predictors of glycaemic control in indigent patients presenting with diabetic ketoacidosis. Diabetes Obes Metab 7: 282–289 | Article | PubMed | ChemPort |
- Maldonado MR et al. (2005) Factors associated with insulin discontinuation in subjects with ketosis-prone diabetes but preserved -cell function. Diabet Med 22: 1744–1750 | Article | PubMed | ChemPort |
Competing interests
The authors declared no competing interests.
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Subject areas under which this article appears: Diabetes (including the metabolic syndrome, hyperglycemia, hyperlipidemia, abdominal obesity, cardiovascular endocrinology) | Diagnosis and screening
