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

Figures & data

Table 1 Inclusion and Exclusion Criteria

Inclusion criteria	T2D	Diabetes duration ≤ 3 months
		Plasma ketones < 0.6 mmol/L and negative urinary ketone bodies, no DKA episodes
		FCP > 1.1 mmol/L
		Without islet-associated autoantibodies
	KPT2D	Diabetes duration ≤ 3 months
		Urinary ketones ≥ 2+ or plasma ketones ≥ 1 mmol/L at diagnosis
		FCP > 1.1 mmol/L or peak C-peptide (oral glucose tolerance test) > 1.5 mmol/L
		Without islet-associated autoantibodies
Exclusion criteria	With long-term alcohol consumption and fasting
	With pregnancy, pancreatitis, and malignant tumors
	With other endocrine disorders and specific types of diabetes mellitus
	With serious liver, kidney, heart or lung diseases

Abbreviations: FCP, fasting C-peptide; KPT2D, ketosis-prone type 2 diabetes; T2D, type 2 diabetes.

Table 2 Comparison of Clinical Characteristics and Anthropometric Features

Variable	KPT2D Group (n=65)	T2D Group (n=82)	P-value
Age, years	39.00 (31.00, 53.00)	51.00 (39.75, 60.00)	<0.001
Male Gender, %	50.00 (76.90%)	48.00 (59.30%)	0.024
Height, cm	170.57 ± 8.87	166.94 ± 7.79	0.006
Weight, kg	76.00 (68.00, 93.00)	73.35 (65.00, 82.48)	0.177
SBP, mmHg	128.00 (117.00, 136.00)	130.5 (120.00, 143.25)	0.088
DBP, mmHg	85.00 (74.00, 91.00)	84.00 (76.75, 91.00)	0.512
BMI, kg/m^2	26.81 (23.83, 30.09)	26.48 (23.57, 29.56)	0.518

Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure; BMI, body mass index; KPT2D, ketosis-prone type 2 diabetes; T2D, type 2 diabetes.

Table 3 Comparison of Biochemical Analysis Between the Groups

Variable	KPT2D Group (n=65)	T2D Group (n=82)	P-value
Total protein, g/L	65.42 ± 7.55	68.00 ± 6.45	0.029
Albumin, g/L	40.44 ± 5.47	42.09 ± 3.54	0.051
ALT, U/L	24.15 (16.88, 49.25)	20.90 (15.43, 31.70)	0.158
AST, U/L	22.80 (15.03, 34.80)	19.40 (16.15, 26.53)	0.368
GGT, mmol/L	36.10 (21.70, 61.90)	31.20 (21.65, 44.00)	0.224
BUN, mmol/L	4.75 (3.83, 5.85)	4.84 (4.30, 6.08)	0.387
SCr, μmol/L	65.35 (55.40, 74.43)	62.55 (52.20, 72.70)	0.362
GFR, mL/min	110.47 (100.74, 124.69)	104.88 (96.40, 114.59)	0.035
Serum uric acid, umol/L	337.65 (266.03, 431.15)	317.25 (262.65, 369.80)	0.129
FBG, mmol/L	12.37 (9.81, 16.00)	8.80 (7.20, 11.24)	<0.001
HbA1c, %	12.00 (11.00, 13.20)	10.1 (8.48, 11.33)	<0.001
Fasting insulin, mmol/L	5.18 (3.21, 11.14)	10.39 (6.69, 19.89)	0.001
Fasting C-peptide, mmol/L	1.46 (1.10, 2.12)	2.82 (1.88, 3.47)	<0.001
HOMA-IR	2.94 (1.92, 5.36)	5.54 (2.12, 7.91)	0.119
HOMA-β	12.79 (6.67, 32.54)	45.40 (24.59, 84.26)	<0.001
TC, mmol/L	5.15 (4.65, 6.36)	4.95 (4.07, 5.71)	0.010
TG, mmol/L	1.99 (1.27, 4.11)	1.52 (1.16, 2.44)	0.045
HDL-C, mmol/L	0.94 (0.77, 1.17)	1.05 (0.88, 1.25)	0.081
LDL-C, mmol/L	3.55 (3.10, 4.26)	3.20 (2.52, 3.76)	0.005
apoA1, mmol/L	0.98 (0.82, 1.23)	1.20 (1.01, 1.40)	0.001
apoB, mmol/L	0.93 (0.83, 1.19)	0.86 (0.69, 1.03)	0.006
AIP	0.34 (0.11, 0.67)	0.18 (−0.02, 0.39)	0.008

Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; GGT, gamma glutamyl transpeptidase; BUN, blood urea nitrogen; SCr, serum creatinine; GFR, glomerular filtration rate; FBG, fasting blood glucose; HbA1c, glycosylated hemoglobin; TC, serum total cholesterols; TG, serum triglycerides; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; apoA1, Apolipoprotein A1; apoB, Apolipoprotein B; AIP, atherogenic index of plasma; KPT2D, ketosis-prone type 2 diabetes; T2D, type 2 diabetes.

Figure 1 Subgroup analysis between KPT2DM and T2D groups. P = 0.026. *P<0.05.

Abbreviations: AIP, atherogenic index of plasma; KPT2D, ketosis-prone type 2 diabetes; T2D, type 2 diabetes.

Figure 2 Correlation Analysis of Plasma Ketones and AIP in Patients with KPT2D. R = 0.345 P = 0.023.

Abbreviation: AIP, atherogenic index of plasma.

Figure 3 (A) Correlation Analysis of Plasma Ketones and ApoA1 in Patients with KPT2D. R = −0.460 P = 0.002. (B) Correlation Analysis of Plasma Ketones and ApoB in Patients with KPT2D. R = −0.142 P = 0.363.

Abbreviations: ApoA1, Apolipoprotein A1; ApoB, Apolipoprotein B.

Table 4 Parameters of the Binary Logistic Regression Model

Variables	Univariate
	OR (95% CI)	P
Plasma Ketones, mmol/L	1.708 (1.018, 2.865)	0.043

Note: Adjusted variables in Univariate: plasma ketones.

Abbreviation: OR, odds ratio.

Table 5 Multiple Linear Regression of AIP and Relevant Indicators in KPT2D Patients

	B (95%Cl)	SE	β	P
Model 1	0.099 (0.005, 0.315)	0.029	0.473	0.001
Model 2	0.082 (0.020, 0.143)	0.030	0.388	0.011
Model 3	0.072 (0.004, 0.139)	0.033	0.341	0.038
Model 4	0.092 (0.015, 0.169)	0.038	0.437	0.020

Notes: P<0.05 was considered significant. Model 1 was not corrected for any factors, Model 2 (adjusted for gender, age, and height), Model 3 (adjusted for gender, age, height, total protein, and GFR) and Model 4 (adjusted for gender, age, height, total protein, GFR, FBG, and HbA1c).

Abbreviations: B, Unstandardized Coefficients; SE, Standard Error; β, Standardized Regression Coefficient.

Table 6 Multiple Linear Regression of apoA1 and Relevant Indicators in KPT2D Patients

	B (95%Cl)	SE	β	P
Model 1	−0.073 (−0.118,-0.027)	0.023	−0.448	0.003
Model 2	−0.060 (−0.110,-0.010)	0.025	−0.370	0.021
Model 3	−0.052 (−0.098, −0.006)	0.023	−0.322	0.027
Model 4	−0.058 (−0.110, −0.005)	0.026	−0.335	0.033

Notes: P<0.05 was considered significant. Model 1 was not corrected for any factors, Model 2 (adjusted for age, gender, and BMI), Model 3 (adjusted for age, gender, BMI, AIP, apoB, LDL, and HDL) and Model 4 (adjusted for age, gender, BMI, AIP, apoB, LDL, HDL, FBG, and HbA1c).

Abbreviations: B, Unstandardized Coefficients; SE, Standard Error; β, Standardized Regression Coefficient.