HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Balasubramanyam, A. Articles by Maldonado, M. R. Search for Related Content PubMed PubMed Citation Articles by Balasubramanyam, A. Articles by Maldonado, M. R. Social Bookmarking                What's this?

Accuracy and Predictive Value of Classification Schemes for Ketosis-Prone Diabetes

¹ Translational Metabolism Unit, Baylor College of Medicine, Houston, Texas
² Endocrine Service, Ben Taub General Hospital, Houston, Texas
³ Robert H. Williams Laboratory, University of Washington, Seattle, Washington

Address correspondence and reprint requests to Mario Maldonado, MD, Translational Metabolism Unit, Baylor College of Medicine, One Baylor Plaza, Room 520 N, Houston, TX 77030. E-mail: mrmaldonado{at}pol.net

OBJECTIVE—Ketosis-prone diabetes (KPD) is an emerging, heterogeneous syndrome. A sound classification scheme for KPD is essential to guide clinical practice and pathophysiologic studies. Four schemes have been used and are based on immunologic criteria, immunologic criteria and insulin requirement, BMI, and immunologic criteria and ß-cell function (Aß classification). The aim of the present study is to compare the four schemes for accuracy and predictive value in determining whether KPD patients have absent or preserved ß-cell function, which is a strong determinant of long-term insulin dependence and clinical phenotype.

RESEARCH DESIGN AND METHODS—Consecutive patients (n = 294) presenting with diabetic ketoacidosis and followed for 12–60 months were classified according to all four schemes. They were evaluated longitudinally for ß-cell autoimmunity, clinical and biochemical features, ß-cell function, and insulin dependence. ß-Cell function was defined by peak plasma C-peptide response to glucagon 1.5 ng/ml. The accuracy of each scheme to predict absent or preserved ß-cell function after 12 months of follow-up was tested using multiple statistical analyses.

RESULTS—The "Aß" classification scheme was the most accurate overall, with a sensitivity and specificity of 99.4 and 95.9%, respectively, positive and negative likelihood ratios of 24.55 and 0.01, respectively, and an area under the receiver operator characteristic curve of 0.972.

CONCLUSIONS—The Aß scheme has the highest accuracy and predictive value in classifying KPD patients with regard to clinical outcomes and pathophysiologic subtypes.

Abbreviations: ADA, American Diabetes Association • AUC, area under the curve • DKA, diabetic ketoacidosis • GAD, glutamic acid decarboxylase • KPD, ketosis-prone diabetes • KDP-ID, KPD–insulin dependent • KDP-NID, KDP–noninsulin dependent • LR, likelihood ratio • PPV, positive predictive value • NPV, negative predictive value • ROC, receiver operating characteristic

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				R. Nalini, L. K. Gaur, M. Maldonado, C. S. Hampe, L. Rodriguez, G. Garza, A. Lernmark, and A. Balasubramanyam HLA Class II Alleles Specify Phenotypes of Ketosis-Prone Diabetes Diabetes Care, June 1, 2008; 31(6): 1195 - 1200. [Abstract] [Full Text] [PDF]

				A. Balasubramanyam, R. Nalini, C. S. Hampe, and M. Maldonado Syndromes of Ketosis-Prone Diabetes Mellitus Endocr. Rev., May 1, 2008; 29(3): 292 - 302. [Abstract] [Full Text] [PDF]

				C. Fernandez, M. Gimenez, G. Diaz, and I. Conget Accuracy and Predictive Value of Classification Schemes for Ketosis-Prone Diabetes: Response to Balasubramanyam et al. Diabetes Care, September 1, 2007; 30(9): e96 - e96. [Full Text] [PDF]

				A. Balasubramanyam and M. Maldonado Accuracy and Predictive Value of Classification Schemes for Ketosis-Prone Diabetes: Response to Fernandez et al. Diabetes Care, September 1, 2007; 30(9): e97 - e97. [Full Text] [PDF]

				C. S. Hampe, R. Nalini, M. R. Maldonado, T. R. Hall, G. Garza, D. Iyer, and A. Balasubramanyam Association of Amino-Terminal-Specific Antiglutamate Decarboxylase (GAD65) Autoantibodies with {beta}-Cell Functional Reserve and a Milder Clinical Phenotype in Patients with GAD65 Antibodies and Ketosis-Prone Diabetes Mellitus J. Clin. Endocrinol. Metab., February 1, 2007; 92(2): 462 - 467. [Abstract] [Full Text] [PDF]

				G. E. Umpierrez Ketosis-Prone Type 2 Diabetes: Time to revise the classification of diabetes Diabetes Care, December 1, 2006; 29(12): 2755 - 2757. [Full Text] [PDF]