{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T01:33:16Z","timestamp":1793410396309,"version":"4.5.0"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2024,1,19]],"date-time":"2024-01-19T00:00:00Z","timestamp":1705622400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,1,19]],"date-time":"2024-01-19T00:00:00Z","timestamp":1705622400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100007112","name":"University of Cape Town","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100007112","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Diabetologia"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Aims\/hypothesis<\/jats:title>\n                <jats:p>The aim of this work was to describe the phenotype of adults presenting with a first episode of diabetic ketoacidosis (DKA) in Cape Town, South Africa, and identify predictors of insulin independence at 12 and 60 months after presentation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A prospective, descriptive cohort study of all individuals, 18 years or older, presenting for the first time with DKA to four public-sector hospitals of the Groote Schuur Academic Health Complex was performed. Clinical, biochemical and laboratory data including GAD antibody and C-peptide status were collected at baseline. Insulin was systematically weaned and stopped in individuals who achieved normoglycaemia within the months after DKA. Individuals were followed for 12 months and then annually until 5 years after initial presentation with ketoacidosis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Eighty-eight individuals newly diagnosed with diabetes when presenting with DKA were included and followed for 5 years. The mean \u00b1 SD age was 35\u00b110 years and the median (IQR) BMI at diagnosis was 28.5 (23.3\u201333.4) kg\/m<jats:sup>2<\/jats:sup>. Overall, 46% were insulin independent 12 months after diagnosis and 26% remained insulin independent 5 years after presentation. Forty-one participants (47%) tested negative for anti-GAD and anti-IA-2 antibodies and had C-peptide levels &gt;0.3 nmol\/l; in this group, 68% were insulin independent at 12 months and 37% at 5 years after diagnosis. The presence of acanthosis nigricans was strongly associated with insulin independence (OR 27.1 [95% CI 7.2, 102.2]; <jats:italic>p<\/jats:italic>&lt;0.001); a positive antibody status was associated with a lower likelihood of insulin independence at 12 months (OR 0.10 [95% CI 0.03, 0.36]; <jats:italic>p<\/jats:italic>&lt;0.001). On multivariable analysis only acanthosis (OR 11.5 [95% CI 2.5, 53.2]; <jats:italic>p<\/jats:italic>=0.004) was predictive of insulin independence 5 years after diagnosis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions\/interpretation<\/jats:title>\n                <jats:p>The predominant phenotype of adults presenting with a first episode of DKA in Cape Town, South Africa, was that of ketosis-prone type 2 diabetes. These individuals presented with obesity, acanthosis nigricans, negative antibodies and normal C-peptide and could potentially be weaned off insulin at follow-up. Classic type 1 diabetes (lower weight, antibody positivity, low or unrecordable C-peptide levels and long-term insulin dependence) was less common. The simple clinical sign of acanthosis nigricans is a strong predictor of insulin independence at 12 months and 5 years after initial presentation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Graphical Abstract<\/jats:title>\n                \n              <\/jats:sec>","DOI":"10.1007\/s00125-023-06067-3","type":"journal-article","created":{"date-parts":[[2024,1,19]],"date-time":"2024-01-19T05:02:19Z","timestamp":1705640539000},"page":"494-505","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Phenotype and predictors of insulin independence in adults presenting with diabetic ketoacidosis: a prospective cohort study"],"prefix":"10.1007","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5416-1286","authenticated-orcid":false,"given":"Peter J.","family":"Raubenheimer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Skelton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bukiwe","family":"Peya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3084-7408","authenticated-orcid":false,"given":"Joel A.","family":"Dave","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6480-8066","authenticated-orcid":false,"given":"Naomi S.","family":"Levitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,1,19]]},"reference":[{"issue":"17","key":"6067_CR1","doi-asserted-by":"publisher","first-page":"1925","DOI":"10.1001\/archinte.164.17.1925","volume":"164","author":"CA Newton","year":"2004","unstructured":"Newton CA, Raskin P (2004) Diabetic ketoacidosis in type 1 and type 2 diabetes mellitus: clinical and biochemical differences. Arch Intern Med 164(17):1925\u20131931. https:\/\/doi.org\/10.1001\/archinte.164.17.1925","journal-title":"Arch Intern Med"},{"issue":"3","key":"6067_CR2","doi-asserted-by":"publisher","first-page":"645","DOI":"10.2337\/diabetes.53.3.645","volume":"53","author":"F Mauvais-Jarvis","year":"2004","unstructured":"Mauvais-Jarvis F, Sobngwi E, Porcher R et al (2004) Ketosis-prone type 2 diabetes in patients of sub-Saharan African origin clinical pathophysiology and natural history of \u03b2-cell dysfunction and insulin resistance. Diabetes 53(3):645\u2013653. https:\/\/doi.org\/10.2337\/diabetes.53.3.645","journal-title":"Diabetes"},{"issue":"11","key":"6067_CR3","doi-asserted-by":"publisher","first-page":"5090","DOI":"10.1210\/jc.2003-030180","volume":"88","author":"M Maldonado","year":"2003","unstructured":"Maldonado M, Hampe CS, Gaur LK et al (2003) Ketosis-prone diabetes: dissection of a heterogeneous syndrome using an immunogenetic and -cell functional classification, prospective analysis, and clinical outcomes. J Clin Endocrinol Metab 88(11):5090\u20135098. https:\/\/doi.org\/10.1210\/jc.2003-030180","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"6067_CR4","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1001\/archinte.1997.00440270117011","volume":"157","author":"GE Umpierrez","year":"1997","unstructured":"Umpierrez GE, Kelly JP, Navarrete JE, Casals MM, Kitabchi AE (1997) Hyperglycemic crises in urban blacks. Arch Intern Med 157(6):669\u2013675. https:\/\/doi.org\/10.1001\/archinte.1997.00440270117011","journal-title":"Arch Intern Med"},{"issue":"2","key":"6067_CR5","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1016\/j.diabres.2012.05.004","volume":"97","author":"H Tan","year":"2012","unstructured":"Tan H, Zhou Y, Yu Y (2012) Characteristics of diabetic ketoacidosis in Chinese adults and adolescents \u2013 a teaching hospital-based analysis. Diabetes Res Clin Pract 97(2):306\u2013312. https:\/\/doi.org\/10.1016\/j.diabres.2012.05.004","journal-title":"Diabetes Res Clin Pract"},{"issue":"12","key":"6067_CR6","doi-asserted-by":"publisher","first-page":"2755","DOI":"10.2337\/dc06-1870","volume":"29","author":"GE Umpierrez","year":"2006","unstructured":"Umpierrez GE (2006) Ketosis-prone type 2 diabetes: time to revise the classification of diabetes. Diabetes Care 29(12):2755\u20132757. https:\/\/doi.org\/10.2337\/dc06-1870","journal-title":"Diabetes Care"},{"issue":"7","key":"6067_CR7","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1038\/ncpendmet0516","volume":"3","author":"MA Banerji","year":"2007","unstructured":"Banerji MA, Dham S (2007) A comparison of classification schemes for ketosis-prone diabetes. Nat Clin Pract Endocrinol Metab 3(7):506\u2013507. https:\/\/doi.org\/10.1038\/ncpendmet0516","journal-title":"Nat Clin Pract Endocrinol Metab"},{"issue":"12","key":"6067_CR8","doi-asserted-by":"publisher","first-page":"E1","DOI":"10.1038\/ncpendmet0698","volume":"3","author":"R Nalini","year":"2007","unstructured":"Nalini R, Maldonado M, Balasubramanyam A (2007) Re: a comparison of classification schemes for ketosis-prone diabetes. Nat Clin Pract Endocrinol Metab 3(12):E1. https:\/\/doi.org\/10.1038\/ncpendmet0698","journal-title":"Nat Clin Pract Endocrinol Metab"},{"issue":"3","key":"6067_CR9","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1210\/er.2007-0026","volume":"29","author":"A Balasubramanyam","year":"2008","unstructured":"Balasubramanyam A, Nalini R, Hampe CS, Maldonado M (2008) Syndromes of ketosis-prone diabetes mellitus. Endocr Rev 29(3):292\u2013302. https:\/\/doi.org\/10.1210\/er.2007-0026","journal-title":"Endocr Rev"},{"issue":"1","key":"6067_CR10","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1046\/j.1464-5491.2001.00395.x","volume":"18","author":"SI McFarlane","year":"2001","unstructured":"McFarlane SI, Chaiken RL, Hirsch S, Harrington P, Lebovitz HE, Banerji MA (2001) Near-normoglycaemic remission in African-Americans with type 2 diabetes mellitus is associated with recovery of beta cell function. Diabetic Med J Br Diabetic Assoc 18(1):10\u201316. https:\/\/doi.org\/10.1046\/j.1464-5491.2001.00395.x","journal-title":"Diabetic Med J Br Diabetic Assoc"},{"issue":"7","key":"6067_CR11","doi-asserted-by":"publisher","first-page":"790","DOI":"10.2337\/diab.44.7.790","volume":"44","author":"GE Umpierrez","year":"1995","unstructured":"Umpierrez GE, Casals MM, Gebhart SP, Mixon PS, Clark WS, Phillips LS (1995) Diabetic ketoacidosis in obese African-Americans. Diabetes 44(7):790\u2013795. https:\/\/doi.org\/10.2337\/diab.44.7.790","journal-title":"Diabetes"},{"issue":"8","key":"6067_CR12","doi-asserted-by":"publisher","first-page":"971","DOI":"10.4158\/EP161679.RA","volume":"23","author":"P Vellanki","year":"2017","unstructured":"Vellanki P, Umpierrez GE (2017) Diabetic ketoacidosis: a common debut of diabetes among African Americans with type 2 diabetes. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol 23(8):971\u2013978. https:\/\/doi.org\/10.4158\/EP161679.RA","journal-title":"Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol"},{"issue":"11","key":"6067_CR13","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1007\/s11892-018-1075-4","volume":"18","author":"HE Lebovitz","year":"2018","unstructured":"Lebovitz HE, Banerji MA (2018) Ketosis-prone diabetes (Flatbush diabetes): an emerging worldwide clinically important entity. Curr Diabetes Rep 18(11):120. https:\/\/doi.org\/10.1007\/s11892-018-1075-4","journal-title":"Curr Diabetes Rep"},{"key":"6067_CR14","unstructured":"World Health Organization (2019) Classification of diabetes mellitus. Geneva"},{"issue":"6","key":"6067_CR15","doi-asserted-by":"publisher","first-page":"741","DOI":"10.2337\/diab.43.6.741","volume":"43","author":"MA Banerji","year":"1994","unstructured":"Banerji MA, Chaiken RL, Huey H et al (1994) GAD antibody negative NIDDM in adult black subjects with diabetic ketoacidosis and increased frequency of human leukocyte antigen DR3 and DR4: Flatbush diabetes. Diabetes 43(6):741\u2013745. https:\/\/doi.org\/10.2337\/diab.43.6.741","journal-title":"Diabetes"},{"issue":"12","key":"6067_CR16","doi-asserted-by":"publisher","first-page":"1364","DOI":"10.4158\/EP15778.OR","volume":"21","author":"M Zhang","year":"2015","unstructured":"Zhang M, Li Y, Cui W et al (2015) The clinical and metabolic characteristics of young-onset ketosis-prone type 2 diabetes in China. Endocr Pract 21(12):1364\u20131371. https:\/\/doi.org\/10.4158\/EP15778.OR","journal-title":"Endocr Pract"},{"issue":"2","key":"6067_CR17","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1007\/s12020-009-9301-0","volume":"37","author":"Y Iwasaki","year":"2010","unstructured":"Iwasaki Y, Hamamoto Y, Kawasaki Y et al (2010) Japanese cases of acute onset diabetic ketosis without acidosis in the absence of glutamic acid decarboxylase autoantibody. Endocrine 37(2):286\u2013288. https:\/\/doi.org\/10.1007\/s12020-009-9301-0","journal-title":"Endocrine"},{"issue":"3","key":"6067_CR18","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/j.jdiacomp.2006.01.005","volume":"20","author":"MA Ramos-Roman","year":"2006","unstructured":"Ramos-Roman MA, Pinero-Pilona A, Adams-Huet B, Raskin P (2006) Comparison of type 1, type 2, and atypical ketosis-prone diabetes at 4 years of diabetes duration. J Diabetes Complications 20(3):137\u2013144. https:\/\/doi.org\/10.1016\/j.jdiacomp.2006.01.005","journal-title":"J Diabetes Complications"},{"issue":"8","key":"6067_CR19","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1111\/j.1464-5491.2004.01249.x","volume":"21","author":"A Jabbar","year":"2004","unstructured":"Jabbar A, Farooqui K, Habib A, Islam N, Haque N, Akhter J (2004) Clinical characteristics and outcomes of diabetic ketoacidosis in Pakistani adults with type 2 diabetes mellitus. Diabet Med 21(8):920\u2013923. https:\/\/doi.org\/10.1111\/j.1464-5491.2004.01249.x","journal-title":"Diabet Med"},{"issue":"9","key":"6067_CR20","doi-asserted-by":"publisher","first-page":"1401","DOI":"10.1016\/j.jdiacomp.2017.06.008","volume":"31","author":"RD Gupta","year":"2017","unstructured":"Gupta RD, Ramachandran R, Gangadhara P et al (2017) Clinical characteristics, beta-cell dysfunction and treatment outcomes in patients with A-beta+ ketosis-prone diabetes (KPD): the first identified cohort amongst Asian Indians. J Diabetes Complications 31(9):1401\u20131407. https:\/\/doi.org\/10.1016\/j.jdiacomp.2017.06.008","journal-title":"J Diabetes Complications"},{"issue":"1","key":"6067_CR21","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.pcd.2011.11.001","volume":"6","author":"JC Low","year":"2012","unstructured":"Low JC, Felner EI, Muir AB et al (2012) Do obese children with diabetic ketoacidosis have type 1 or type 2 diabetes? Prim Care Diabetes 6(1):61\u201365. https:\/\/doi.org\/10.1016\/j.pcd.2011.11.001","journal-title":"Prim Care Diabetes"},{"issue":"4","key":"6067_CR22","doi-asserted-by":"publisher","first-page":"e938","DOI":"10.1542\/peds.2013-2795","volume":"133","author":"D Dabelea","year":"2014","unstructured":"Dabelea D, Rewers A, Stafford JM et al (2014) Trends in the prevalence of ketoacidosis at diabetes diagnosis: the SEARCH for diabetes in youth study. Pediatrics 133(4):e938-945. https:\/\/doi.org\/10.1542\/peds.2013-2795","journal-title":"Pediatrics"},{"issue":"3","key":"6067_CR23","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1111\/dme.13264","volume":"34","author":"E Lontchi-Yimagou","year":"2017","unstructured":"Lontchi-Yimagou E, Nguewa JL, Assah F et al (2017) Ketosis-prone atypical diabetes in Cameroonian people with hyperglycaemic crisis: frequency, clinical and metabolic phenotypes. Diabet Med 34(3):426\u2013431. https:\/\/doi.org\/10.1111\/dme.13264","journal-title":"Diabet Med"},{"key":"6067_CR24","first-page":"97","volume":"130","author":"F Djrolo","year":"2011","unstructured":"Djrolo F, Amoussou-Geiuenou D, Wanvoegbe A, Glitho S (2011) Ketosis-prone atypical diabetes mellitus in Cotonou. Louvain Med 130:97\u201398 ([Article in French])","journal-title":"Louvain Med"},{"issue":"suppl 4","key":"6067_CR25","first-page":"605","volume":"23","author":"L Lokrou","year":"2006","unstructured":"Lokrou L, Abodo J, Koffi D, Sanogo M, Amani F, Doumbia A (2006) Emergence of atypical diabetes in black African subjects. Diabet Med 23(suppl 4):605","journal-title":"Diabet Med"},{"issue":"7","key":"6067_CR26","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1002\/(SICI)1096-9136(199707)14:7<603::AID-DIA406>3.0.CO;2-V","volume":"14","author":"M Zouvanis","year":"1997","unstructured":"Zouvanis M, Pieterse AC, Seftel HC, Joffe BI (1997) Clinical characteristics and outcome of hyperglycaemic emergencies in Johannesburg Africans. Diabetic Med J Br Diabetic Assoc 14(7):603\u2013606. https:\/\/doi.org\/10.1002\/(SICI)1096-9136(199707)14:7%3c603::AID-DIA406%3e3.0.CO;2-V","journal-title":"Diabetic Med J Br Diabetic Assoc"},{"issue":"1","key":"6067_CR27","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1093\/qjmed\/94.1.39","volume":"94","author":"P Rheeder","year":"2001","unstructured":"Rheeder P, Stolk RP, Grobbee DE (2001) Ethnic differences in C-peptide levels and anti-GAD antibodies in South African patients with diabetic ketoacidosis. QJM\u202f: Monthly J Assoc Phys 94(1):39\u201343. https:\/\/doi.org\/10.1093\/qjmed\/94.1.39","journal-title":"QJM : Monthly J Assoc Phys"},{"issue":"12","key":"6067_CR28","doi-asserted-by":"publisher","first-page":"2575","DOI":"10.2337\/dc06-0749","volume":"29","author":"A Balasubramanyam","year":"2006","unstructured":"Balasubramanyam A, Garza G, Rodriguez L et al (2006) Accuracy and predictive value of classification schemes for ketosis-prone diabetes. Diabetes Care 29(12):2575\u20132579. https:\/\/doi.org\/10.2337\/dc06-0749","journal-title":"Diabetes Care"},{"issue":"2","key":"6067_CR29","first-page":"196","volume":"23","author":"C Ekpebegh","year":"2013","unstructured":"Ekpebegh C, Longo-Mbenza B, Blanco-Blanco E (2013) Islet immunity and beta cell reserve of indigenous black south Africans with ketoacidosis at initial diagnosis of diabetes. Ethnic Dis 23(2):196\u2013201","journal-title":"Ethnic Dis"},{"issue":"1","key":"6067_CR30","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1111\/j.1399-5448.2009.00519.x","volume":"11","author":"LL Liu","year":"2010","unstructured":"Liu LL, Lawrence JM, Davis C et al (2010) Prevalence of overweight and obesity in youth with diabetes in USA: the SEARCH for Diabetes in Youth study. Pediatr Diabetes 11(1):4\u201311. https:\/\/doi.org\/10.1111\/j.1399-5448.2009.00519.x","journal-title":"Pediatr Diabetes"},{"issue":"3","key":"6067_CR31","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1016\/j.jpeds.2015.05.046","volume":"167","author":"SN DuBose","year":"2015","unstructured":"DuBose SN, Hermann JM, Tamborlane WV et al (2015) Obesity in youth with type 1 diabetes in Germany, Austria, and the United States. J Pediatr 167(3):627-632 e621-624. https:\/\/doi.org\/10.1016\/j.jpeds.2015.05.046","journal-title":"J Pediatr"},{"issue":"2","key":"6067_CR32","doi-asserted-by":"publisher","first-page":"243","DOI":"10.4158\/ep12287.or","volume":"19","author":"R Fernandez","year":"2013","unstructured":"Fernandez R, Misra R, Nalini R, Hampe CS, Ozer K, Balasubramanyam A (2013) Characteristics of patients with ketosis-prone diabetes (KPD) presenting with acute pancreatitis: implications for the natural history and etiology of a KPD subgroup. Endocr Pract 19(2):243\u2013251. https:\/\/doi.org\/10.4158\/ep12287.or","journal-title":"Endocr Pract"},{"issue":"9","key":"6067_CR33","doi-asserted-by":"publisher","first-page":"e96","DOI":"10.2337\/dc07-0400","volume":"30","author":"C Fernandez","year":"2007","unstructured":"Fernandez C, Gimenez M, Diaz G, Conget I (2007) Accuracy and predictive value of classification schemes for ketosis-prone diabetes. Diabetes Care 30(9):e96. https:\/\/doi.org\/10.2337\/dc07-0400. (author reply e97)","journal-title":"Diabetes Care"},{"key":"6067_CR34","unstructured":"Statistics South Africa (2022) Statistical Release P0302. Mid-year population estimates 2022. https:\/\/www.statssa.gov.za\/publications\/P0302\/P03022022.pdf. Accessed\u00a016 Nov 2023"},{"issue":"3","key":"6067_CR35","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1002\/bimj.201700067","volume":"60","author":"G Heinze","year":"2018","unstructured":"Heinze G, Wallisch C, Dunkler D (2018) Variable selection - a review and recommendations for the practicing statistician. Biom J 60(3):431\u2013449. https:\/\/doi.org\/10.1002\/bimj.201700067","journal-title":"Biom J"},{"issue":"4","key":"6067_CR36","doi-asserted-by":"publisher","first-page":"479","DOI":"10.2337\/diacare.20.4.479","volume":"20","author":"GE Umpierrez","year":"1997","unstructured":"Umpierrez GE, Clark WS, Steen MT (1997) Sulfonylurea treatment prevents recurrence of hyperglycemia in obese African-American patients with a history of hyperglycemic crises. Diabetes Care 20(4):479\u2013483. https:\/\/doi.org\/10.2337\/diacare.20.4.479","journal-title":"Diabetes Care"},{"issue":"6","key":"6067_CR37","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1002\/dmrr.2421","volume":"29","author":"H Seok","year":"2013","unstructured":"Seok H, Jung CH, Kim SW et al (2013) Clinical characteristics and insulin independence of Koreans with new-onset type 2 diabetes presenting with diabetic ketoacidosis. Diabetes Metab Res Rev 29(6):507\u2013513. https:\/\/doi.org\/10.1002\/dmrr.2421","journal-title":"Diabetes Metab Res Rev"},{"issue":"11","key":"6067_CR38","doi-asserted-by":"publisher","first-page":"1948","DOI":"10.2337\/dc16-0406","volume":"39","author":"P Vellanki","year":"2016","unstructured":"Vellanki P, Smiley DD, Stefanovski D et al (2016) Randomized controlled study of metformin and sitagliptin on long-term normoglycemia remission in African American patients with hyperglycemic crises. Diabetes Care 39(11):1948\u20131955. https:\/\/doi.org\/10.2337\/dc16-0406","journal-title":"Diabetes Care"},{"issue":"2","key":"6067_CR39","doi-asserted-by":"publisher","first-page":"e106799","DOI":"10.5812\/ijem.106799","volume":"19","author":"SS Waddankeri","year":"2021","unstructured":"Waddankeri SS, Swaraj Waddankeri M, Gurushantappa Mangshetty B (2021) Clinical and biochemical characteristics and treatment outcomes of ketosis-prone diabetes: the remission prone diabetes. Int J Endocrinol Metab 19(2):e106799. https:\/\/doi.org\/10.5812\/ijem.106799","journal-title":"Int J Endocrinol Metab"},{"issue":"4","key":"6067_CR40","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1007\/s00125-021-05644-8","volume":"65","author":"D Kibirige","year":"2022","unstructured":"Kibirige D, Sekitoleko I, Lumu W et al (2022) Understanding the pathogenesis of lean non-autoimmune diabetes in an African population with newly diagnosed diabetes. Diabetologia 65(4):675\u2013683. https:\/\/doi.org\/10.1007\/s00125-021-05644-8","journal-title":"Diabetologia"},{"issue":"9733","key":"6067_CR41","doi-asserted-by":"publisher","first-page":"2254","DOI":"10.1016\/S0140-6736(10)60550-8","volume":"375","author":"JC Mbanya","year":"2010","unstructured":"Mbanya JC, Motala AA, Sobngwi E, Assah FK, Enoru ST (2010) Diabetes in sub-Saharan Africa. Lancet 375(9733):2254\u20132266. https:\/\/doi.org\/10.1016\/S0140-6736(10)60550-8","journal-title":"Lancet"},{"issue":"1","key":"6067_CR42","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1186\/s12902-021-00812-8","volume":"21","author":"S Bhola","year":"2021","unstructured":"Bhola S, Cave EM, Bhana S, Crowther NJ, Padoa CJ (2021) Zinc transporter 8 (ZnT8) autoantibody prevalence in black South African participants with type 1 diabetes. BMC Endocr Disord 21(1):151. https:\/\/doi.org\/10.1186\/s12902-021-00812-8","journal-title":"BMC Endocr Disord"}],"container-title":["Diabetologia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00125-023-06067-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00125-023-06067-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00125-023-06067-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T12:05:23Z","timestamp":1707134723000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00125-023-06067-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,19]]},"references-count":42,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["6067"],"URL":"https:\/\/doi.org\/10.1007\/s00125-023-06067-3","relation":{},"ISSN":["0012-186X","1432-0428"],"issn-type":[{"value":"0012-186X","type":"print"},{"value":"1432-0428","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,19]]},"assertion":[{"value":"24 August 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 November 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 January 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data availability"}},{"value":"This work was partially funded by a Discovery Foundation Academic Fellowship award to JS. The funding source had no role in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors\u2019 relationships and activities"}},{"value":"PJR, JS and NSL were involved in the conception and design of the study. PJR, JS, BP, JAD and NSL were involved in the conduct of the study and the analysis and interpretation of the results. PJR wrote the first draft of the manuscript and all authors edited, reviewed and approved the final version. PJR is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Contribution statement"}}]}}