KETOACIDOSIS IN APACHE INDIANS WITH NON-INSULIN-DEPENDENT DIABETES-MELLITUS

Background: Although more classically associated with insulin-dependen t diabetes mellitus, diabetic ketoacidosis (DKA) can occur in some pat ients with non-insulin-dependent diabetes mellitus (NIDDM). To better define the clinical features that may be associated with ketoacidosis in patients sith NIDDM, we reviewed the medical histories of Apache In dians with NIDDM who had been treated for an episode of DKA. Methods: Cases of ketoacidosis among patients with NIDDM were identified at 2 s eparate Apache Indian reservations. Chart data were used to confirm an d characterize the diagnosis of NIDDM, the metabolic disturbances asso ciated with DKA, and the historical features of the patients. Results: Among 723 patients with NIDDM, 17 patients experiencing at least 1 ep isode of DKA were identified. The mean (+/-SD) age at the time of the episode was 40.8+/-13.9 years, The patients were predominantly male (1 5[88%]), with a mean (+/-SD) body mass index (calculated as the weight in kilograms divided by the square of the height in meters) of 24.9+/ -4.4 kg/m(2). Causes of DKA included infections (8[47%]) and omission of treatment (3/15[20%]). Concurrent abuse of alcohol was noted in 4 ( 27%) of the patients, In addition, a lifetime history of alcohol abuse was noted in 15 (94%) of 16 patients. Conclusions: This report confir ms the growing recognition that DKA, occurs in some patients with NIDD M. The present study also adds male sex, alcohol abuse, and relatively low body mass index as clinical factors that may play a role in the d evelopment of DKA in this setting.