Elevated Serum Triglycerides are Associated with Ketosis-Prone Type 2 Diabetes in Young Individuals

Hui, Ran; Zhang, Hongmei; Wu, Hui; Wen, Li Ming; Du, Shichun; Su, Qing

doi:10.2147/dmso.s296085

Cited by 10 publications

(10 citation statements)

References 22 publications

(37 reference statements)

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“…KPT2D was shown to have a lower age of onset compared to NKPT2D, which was consistent with data reported in a previous study. 19 Also, we found a higher predominance of male patients in the KPT2D group that was close to the rates reported by Ye et al 20 However, the underlying pathogenesis of this phenomenon is not yet clear. Body fat distribution, insulin sensitivity and sex hormones might interact to cause the syndrome.…”

Section: Discussionsupporting

confidence: 89%

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

Wang¹,

Lu²,

Lopes³

et al. 2022

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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.

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Section: Discussionsupporting

confidence: 89%

“… 23 Although patients in both groups had similar insulin sensitivity, their insulin secretion was lower in the KPT2D group suggesting that impairment of β-cell function played an important role in the onset of KPT2D that might be caused by glucotoxicity and glucolipotoxicity. 20 , 24 …”

Section: Discussionmentioning

confidence: 99%

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

Wang¹,

Lu²,

Lopes³

et al. 2022

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“…These patients are more likely to be men with abnormal lipid metabolism and reversible β-cell dysfunction. 22 , 23 In our study, DK or DKA patients with age ≤ 35 were 36 (30 males and 6 females, 29 were negative for glutamic acid decarboxylase antibody (GAD) and/or other pancreatic antibodies), with mean HbA1c 12.07%, fasting C-peptide 0.37 nmol/L, and TG 2.69 mmol/L, which was generally consistent with the current studies reported; we also found the level of 25-OH-VitD3 was 14.76 ng/mL, N-MID 9.87 ng/mL, FT3 4.57 pmol/L, indicating the change of bone and thyroid change in this group. In recent years, the incidence of DK or DKA in patients with T2DM has increased due to a variety of factors, including inappropriate use of oral diabetes drugs (OADs) such as sodium-glucose cotransporter-2 inhibitors (SGLT-2i), infection, loss of diet control, stress, cardiovascular disease, and so on.…”

Section: Discussionmentioning

confidence: 99%

The Comparative Study on the Status of Bone Metabolism and Thyroid Function in Diabetic Patients with or without Ketosis or Ketoacidosis

Xu¹,

Gong²,

Su³

et al. 2022

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Purpose This study aims to identify changes in bone turnover markers and thyroid function in diabetic ketosis (DK) and diabetic ketoacidosis (DKA). Materials and Methods We compared data from the Department of Endocrinology at Shanghai Pudong Hospital from 2018 to 2020 on the pancreatic status and previous glucose control, bone transformation, calcium homeostasis, and thyroid function in groups with diabetes (DM alone, n=602), DK (n=232), and DKA (n=60). Similar comparisons were made in recurrent DK (A) (n=17) and single DK (A) (n=272). Results The fasting C-peptide level decreased significantly, but hemoglobin A1c (HbA1c) levels were higher in DK or DKA (p<0.05). Blood calcium and 25-hydroxyvitamin D3 (25-OH-VitD3) levels were significantly lower in DKA (p<0.05), but parathyroid hormone (PTH) levels remained constant across all three groups. The N-terminal middle molecular fragment of osteocalcin (N-MID) and β-C terminal cross-linking telopeptide of type 1 collagen (β-CTX) showed significant inverse alterations in DKA, regardless of gender or age (p<0.05). Otherwise, DKA significantly inhibited thyroid function (p<0.05). Furthermore, Spearman correlation analyses revealed a relationship between N-MID and HbA1c in DM alone (r=−0.27, p<0.01), while total triiodothyronine (TT3, r=0.62, p<0.01) or free T3 (FT3, r=0.61, p<0.01) in DK, and DKA (TT3, r=0.45, p<0.01; FT3, r=0.43, p<0.01). Multilinear regression analyses revealed that β-CTX (β=0.564), HbA1c (β=−0.196), TT3 (β=0.183), and 25-OH-VitD3 (β=−0.120) were the only independent determinants of N-MID in DM, whereas FT3 (β=0.491), β-CTX (β=0.315) in DK, and FT3 (β=0.420), β-CTX (β=0.367), TG (β=−0.278) in DKA. Only 25-OH-VitD3 was found to be significantly lower in recurrent DK (A) than in single onset DK (A) (p<0.05), and β-CTX (β=0.745) was found to be significantly independently associated with N-MID. Conclusion Our preliminary findings show a dramatic change in bone turnover markers in DM patients with DK and DKA, and this change may be related to thyroid function.

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“…Diabetes type in young adults can be difficult to determine as clinical overlap features are common (eg, obesity may be present in individuals with type 1 diabetes 21 and young adult type 2 diabetes can present with ketosis or ketoacidosis 22 ). The main decision in young adults is to distinguish type 1 diabetes from type 2 diabetes and/or to recognise rarer monogenic forms of diabetes.…”

Section: Recommendationsmentioning

confidence: 99%

Management of type 2 diabetes in young adults aged 18–30 years: ADS/ADEA/APEG consensus statement

Wong

Ross

Zoungas

et al. 2022

Medical Journal of Australia

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Introduction Type 2 diabetes in young adults (nominally, 18–30 years of age) is a more aggressive condition than that seen in older age, with a greater risk of major morbidity and early mortality. This first Australian consensus statement on the management of type 2 diabetes in young adults considers areas where existing type 2 diabetes guidance, directed mainly towards older adults, may not be appropriate or relevant for the young adult population. Where applicable, recommendations are harmonised with current national guidance for type 2 diabetes in children and adolescents (aged < 18 years). The full statement is available at https://www.diabetessociety.com.au, https://www.adea.com.au and https://www.apeg.org.au. Main recommendations Advice is provided on important aspects of care including screening, diabetes type, psychological care, lifestyle, glycaemic targets, pharmacological agents, cardiovascular disease risk management, comorbidity assessment, contraception and pregnancy planning, and patient‐centred education. Special considerations for Aboriginal and Torres Strait Islander Australians are highlighted separately. Changes in management as a result of this statement Management recommendations for young adults, which differ from those for adults, include: ▪screening for diabetes in young adults with overweight or obesity and additional risk factors, including in utero exposure to type 2 diabetes or gestational diabetes mellitus; ▪more stringent glucose targets (glycated haemoglobin ≤ 6.5% [≤ 48 mmol/mol]); ▪in the context of obesity or higher cardio‐renal risk, glucagon‐like peptide 1 receptor agonists and sodium–glucose cotransporter 2 inhibitors are preferred second line agents; ▪β‐cell decline is more rapid, so frequent review, early treatment intensification and avoidance of therapeutic inertia are indicated; ▪a blood pressure target of < 130/80 mmHg, as the adult target of ≤ 140/90 mmHg is too high; ▪absolute cardiovascular disease risk calculators are not likely to be accurate in this age group; early statin use should therefore be considered; and ▪a multidisciplinary model of care including an endocrinologist and a certified diabetes educator.

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Elevated Serum Triglycerides are Associated with Ketosis-Prone Type 2 Diabetes in Young Individuals

Cited by 10 publications

References 22 publications

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

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

The Comparative Study on the Status of Bone Metabolism and Thyroid Function in Diabetic Patients with or without Ketosis or Ketoacidosis

Management of type 2 diabetes in young adults aged 18–30 years: ADS/ADEA/APEG consensus statement

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