Severe diabetes in remission: a Singapore's perspective.

INTRODUCTION Diabetic ketoacidosis is generally thought to be the classical presentation of individuals with Type 1 diabetes. Clinicians are beginning to see individuals with atypical diabetes presenting with severe hyperglycaemia associated with or without ketosis and after the initial period of intensive insulin therapy, becoming non-insulin dependent and remaining in remission for years. So far, these patients have only been identified amongst African Americans and have only recently been reported amongst the Japanese and the Chinese in Hong Kong. We therefore set out to identify the existence of such patients in our population. MATERIALS AND METHODS We have a database of patients admitted for diabetic ketoacidosis. From this, we recruited patients who fulfilled the criteria for atypical diabetes and proceeded to perform a retrospective analysis together with a prospective analysis of their outcome. RESULTS We identified 10 individuals with atypical diabetes with characteristics similar to those previously described. Our data showed that these patients deferred from classical individuals with Type 1 diabetes in the following ways--older age of onset, relatively higher BMI, marked elevation in HBA1c suggesting a significant period and degree of hyperglycaemia and prolonged remission after reversal of hyperglycaemia. CONCLUSIONS Atypical Type 2 diabetes exists in our population. Clinicians looking after individuals with diabetes should be made aware of this as there are important implications in the subsequent management of such patients.