A Cross-Sectional Study of Atherosclerosis in Newly Diagnosed Patients with Ketosis-Prone Type 2 Diabetes

Abstract

Purpose To investigate the prevalence, clinical and metabolic characteristics of atherosclerosis (AS) in newly diagnosed patients with ketosis-prone type 2 diabetes (KPT2D) or non-ketotic type 2 diabetes (NKPT2D). Patients and Methods About 1072 subjects with non-autoimmune new-onset diabetes were included in the cross-sectional study. Patients were classified as non-ketotic type 2 diabetes (NKPT2D, n = 662) or ketosis-prone type 2 diabetes (KPT2D, n = 410). Blood samples were collected to determine the levels of glucose, HbA1c, insulin and C-peptide. Routine liver and kidney function tests were also performed. AS was determined by vascular ultrasonography. Results The levels of fasting blood glucose and HbA1c were significant higher in the KPT2D group when compared to the NKPT2D group (P<0.001). The levels of fasting C-peptide, 2 h C-peptide and HOMA-β were lower in the KPT2D group than those in NKPT2D group (P<0.001). However, no significant difference was observed for HOMA-IR between the two groups. The onset age of the patients with KPT2D was significantly lower compared to NKPT2D patients (38±13 vs 49±14, P<0.001). After adjusting age of the two groups, the KPT2D patients had a higher prevalence of AS compared to the NKPT2D patients (31.4% vs 21.1%, P=0.005). In both groups, age and gender were independent risk factors for AS, whereas estimated glomerular filtration rate (eGFR) was an independent risk factor in the NKPT2D patients and 2-h postprandial plasma glucose (2h-PPG) was an independent risk factor in the KPT2D patients. Conclusion AS was more prevalent in KPT2D patients compared to the NKPT2D cohort, which was independent of age and gender. These data suggest that KPT2D patients may have a higher risk of macrovascular complications compared to NKPT2D of the same age.

Association Between Serum Vitamin D Levels and Ketosis Episodes in Hospitalized Patients with Newly Diagnosed Ketosis-Prone Type 2 Diabetes

“…The result is consistent with the results of previous research. 5 Moreover, our study showed that TG, TC, and LDL-C were significantly increased in patients with KPT2D compared with patients with NKT2D. These findings suggested that glucotoxicity combined with lipotoxicity led to impaired islet function, insulin receptor insensitivity, and ultimately decreased insulin secretion capacity, which resulted in ketone body production.…”

“…3,4 The latest World Health Organization literature defines KPT2D as a hybrid form of diabetes. 5 A recent study suggested that the number of patients with KPT2D has increased rapidly, which can be associated with changes in diet structure and lifestyle. 3 A previous study has suggested that 90% of these individuals will suffer episodes of ketosis within 10 years.…”

High Atherogenic Risk in Ketosis-Prone Type 2 Diabetic Individuals with Ketosis Episodes: A Cross-Sectional Study

“…After age-matching the KPT2D group to the T2D group, the prevalence of (lower limb or carotid) AS was significantly increased in participants with the KPT2D than in participants with T2D. 21 They suggested that ketosis maybe play an important part in the progression of AS.…”

Update on Measuring Ketones

“…11 Other people who are at increased risk of DKA include people with type 2 diabetes (T2D) who are using SGLT2i on label or who have experienced an episode of antibody-negative ketosis-prone diabetes (also known as Flatbush Diabetes), which is the reason for DKA in nearly 50% of African Americans and approximately 50% of African Caribbeans. [12][13][14] A combination of starvation and an alcoholic binge can lead to ketoacidosis in the absence of diabetes, which is known as alcoholic ketoacidosis (AKA). Also, ketoacidosis in the absence of diabetes may rarely occur after a short period of vomiting and is then referred to as starvation ketoacidosis.…”