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

Figures & data

Table 1 Clinical and Anthropometric Features of the KPT2D and NKT2D Groups

Characteristics	KPT2D Group (n = 71)	NKT2D Group (n = 91)	P-value
Clinical characteristics
Age, years	36.00(30.00,47.00)	50.00(38.00,60.00)	0.000
Male Gender (%)	57.00(80.30%)	56.00(61.50%)	0.010
Height, cm	171.77 ±8.68	167.73 ±8.44	0.003
Weight, kg	80.87(70.00,93.50)	74.10(65.70,87.20)	0.087
SBP, mmHg	129.59 ±16.15	134.09 ±16.62	0.086
DBP, mmHg	85.00(75.00,91.00)	84.00(76.00,92.00)	0.837
BMI, kg/m^2	27.00(24.80,30.86)	27.02(23.78,30.02)	0.766

Notes: Continuous data are presented as the means ± Standard deviations (SD) or medians (interquartile ranges, IQR) based on the data distribution. Categorical variables are presented as percentages (%).

Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure; BMI, body mass index; KPT2D, ketosis-prone type 2 diabetes; NKT2D, non-ketotic type 2 diabetes.

Table 2 Laboratory Findings in the KPT2D and NKT2D Groups

Characteristics	KPT2D Group (n = 71)	NKT2D Group (n = 91)	P-value
Biochemical characteristics - baseline
Total protein, g/L	65.25 ±7.81	68.13 ±6.39	0.011
Albumin, g/L	40.76 ±5.39	42.11 ±3.49	0.070
ALT, U/L	27.90(17.80,51.70)	21.20(15.50,33.00)	0.095
AST, U/L	23.50(15.70,35.20)	19.50(16.70,32.10)	0.248
GGT, mmol/L	39.80(23.20,77.70)	32.10(21.20,44.90)	0.065
BUN, mmol/L	4.70(3.70,5.80)	4.80(4.30,6.04)	0.239
SCr, μmol/L	65.40(56.70,74.70)	61.60(52.66,72.70)	0.143
GFR (mL/min)	112.44(101.94,124.78)	105.75(96.02,115.15)	0.006
Serum uric acid, umol/L	342.20(285.40,428.60)	315.43(258.50,361.00)	0.050
Blood calcium levels, mmol/L	2.31 ±0.15	2.30 ±0.11	0.537
25-hydroxy vitamin D, ng/mL	14.20(10.68,19.52)	16.98(13.54,21.96)	0.011
TC, mmol/L	5.44(4.64,6.50)	5.00(4.09,5.85)	0.009
TG, mmol/L	2.13(1.29,4.87)	1.53(1.17,2.52)	0.012
HDL-C, mmol/L	0.91(0.77,1.11)	1.04(0.88,1.23)	0.006
LDL-C, mmol/L	3.67 ±1.03	3.18 ±0.90	0.002
Fasting blood glucose, mmol/L	12.22(9.96,15.45)	8.83(7.20,11.27)	0.000
Hemoglobin A1c, %	12.00(11.00,13.30)	10.30(8.60,11.60)	0.000
Pancreas islet function-baseline
Fasting insulin, mmol/L	6.44(3.45,12.06)	10.39(6.49,19.38)	0.005
Fasting C-peptide, mmol/L	1.47(1.15,2.30)	2.87(1.97,3.50)	0.000
HOMA-IR	3.01(1.97,6.88)	5.61(2.00,7.81)	0.279
HOMA-β	15.79(8.03,33.86)	45.40(20.77,73.60)	0.000
After glucose tolerance test
Fasting blood glucose, mmol/L	6.15(5.43,7.38)	6.06(5.10,7.06)	0.293
2-h postprandial plasma glucose, mmol/L	15.45 ±3.44	14.92 ±4.00	0.679
Fasting C-peptide, mmol/L	1.59(1.17,2.45)	2(1.37,3.09)	0.041
2-h C-peptide, mmol/L	4.84(3.73,7.31)	7.10(4.77,9.63)	0.002
Fasting insulin, mmol/L	5.37(3.24,15.47)	6.71(4.39,13.39)	0.041
2-h insulin, mmol/L	26.80(17.37,46.34)	43.03(25.93,80.44)	0.001
ΔI30/ΔG30	1.13(0.50,2.78)	3.09(1.60,5.94)	0.000
AUCC	12.16(8.90,16.71)	16.11(10.89,27.26)	0.002
AUCI	56.50(28.20,98.78)	91.94(53.80,182.63)	0.001

Notes: Continuous data are presented as the means ±Standard deviations (SD) or medians (interquartile ranges, IQR) based on the data distribution. Categorical variables are presented as percentages (%).

Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; GGT, gamma glutamyl transpeptidase; BUN, blood urea nitrogen; SCr, serum creatinine; GFR, glomerular filtration rate; TC, serum total cholesterols; TG, serum triglycerides; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; ΔI30/ΔG30, early insulin secretory function; AUC_C, AUC of C-peptide; AUC_I, AUC of insulin; KPT2D, ketosis-prone type 2 diabetes; NKT2D, non-ketotic type 2 diabetes.

Figure 1 Distribution of the 25OHD levels in the two groups.

Notes: Comparison of the 25OHD levels between the KPT2D and NKT2D groups, P = 0.011.

Table 3 Correlation Between the 25OHD Level and a Variety of Parameters

	Rs	95%LCI	95%UCI	P
Plasma ketones	−0.387	1.7974	3.0798	0.020
HOMA-β	0.264	23.7509	36.8623	0.031
HOMA-IR	0.062	4.1018	6.8080	0.616
ΔI30/ΔG30	0.223	2.5589	4.6552	0.033
HbA1c	−0.375	11.8123	12.8418	0.022

Notes: Rs: Spearman correlation coefficient or Pearson’s correlation coefficient; P: 25OHD versus variables.

Abbreviations: LCI, lower confidence interval for difference; UCI, upper confidence interval for difference. ΔI30/ΔG30, early insulin secretory function; HbA1c, hemoglobin A1c.

Figure 2 Correlational analysis of the 25OHD levels with HOMA-β and HOMA-IR in all subjects.

Notes: (A) The correlational analysis between the 25OHD level and HOMA-β, P = 0.031; (B) the correlational analysis between the 25OHD level and HOMA-IR, P = 0.616.

Table 4 Parameters of the Binary Logistic Regression Model

Variables	Univariate		Multivariate
	OR (95% CI)	P	OR (95% CI)	P
25OHD	0.924(0.867–0.984)	0.013	0.921(0.853–0.995)	0.037
HbA1c	1.866(1.427–2.44)	0.000	1.643(1.173–2.303)	0.004
FBG	1.223(1.098–1.362)	0.000	1.294(1.08–1.551)	0.005
Total protein	0.934(0.884–0.988)	0.017	0.907(0.827–0.994)	0.037
TG	1.103(1.004–1.212)	0.760	0.974(0.849–1.115)	0.712
LDL-C	1.486(1.003–2.202)	0.048	1.513(0.808–2.833)	0.196
Gender (male)	1.554(0.708–3.412)	0.272	3.448(0.959–12.403)	0.058
Age	0.954(0.927–0.982)	0.001	0.957(0.918–0.997)	0.037

Notes: Adjusted variables in univariate analysis: 25OHD, HbA1c, FBG, total protein, TG, LDL, gender and age. Adjusted variables in multivariate analysis: 25OHD, HbA1c, FBG, total protein, TG, LDL, gender, and age.

Abbreviations OR, odds ratio; HbA1c, hemoglobin A1c; FBG, fasting blood glucose; TG, serum triglycerides; LDL-C, low-density lipoprotein cholesterol; 25OHD, 25-hydroxy vitamin D.