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The onset of diabetes mellitus secondary to emotional stress has been cited frequently in the literature. Balasubramanyam et al. and Umpierrez suggested a need for a more accurate classification (Aβ c...lassification) of ketosis-prone diabetes (KPD) in recent articles, including their own aimed at guiding clinical practice and pathophysiological studies. KPD, an emerging form of diabetes defined by presentation with diabetic ketoacidois, is phenotypically heterogeneous. We have read their study with great interest and wondered whether there were any stressful life events before the actual “onset” of ketosis and/or ketoacidosis in their cases (specially, Type 2B A－β ＋)1)-3). Psychological stress is widely recognized among the environmental factors playing a role the development of diabetes. However, this concept is vague, and there are individual differences, so it is difficult to provide direct substantiation in humans with exacerbating factors other than hyperglycemia or stress stimulus. The authors have treated some cases, which have been tentatively referred to as emotional stress-induced Atypical “KPD”.show more
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