Ketosis-onset diabetes associated with acanthosis nigricans: A sign of long-term insulin-dependency?

✍ Scribed by Chan, NN ;Darko, D ;O'Shea, D ;Feher, MD

• Publisher: John Wiley and Sons
• Year: 1999
• Tongue: English
• Weight: 271 KB
• Volume: 16
• Category: Article
• ISSN: 1357-8170
• DOI: 10.1002/pdi.1960160714

✦ Synopsis

Abstract

Acanthosis nigricans is a cutaneous marker of insulin resistance, hyperinsu‐linaemia and obesity, and is often seen clinically in association with impaired glucose tolerance and type 2 diabetes mellitus^1,2.^ Ketosis in type 2 diabetes, with^3,4^ or without metabolic acidosis,^5^ has been reported in patients with acanthosis nigricans, who required large doses of insulin to achieve adequate glycaemic control, reflecting the co‐existent insulin‐resistant state. Recently the classification of type 1 and type 2 diabetes has been debated, with a view that these metabolic states should no longer be regarded as separate entities but rather as a continuum,^5^ since it has been shown that the presence of ketosis does not necessarily predict future insulin‐dependency. This has been illustrated in several cases in which patients fell into the category of ‘ketosis‐onset diabetes with subsequent non‐insulin‐dependency’^5−7^ We describe two cases of ketosis‐onset diabetes with cutaneous signs of insulin resistance (acanthosis nigricans) as further evidence to suggest that long‐term insulin is not always required in this category of patients.