The Clinical Features Of Macrovascular Diseases In Newly Diagnosed Diabetes With Ketosis-onset But Without Islet-associated Autoantibodies

Objective: The features of macrovascular diseases in ketosis-onset diabetic patientswho are without islet-associated autoantibodies have not been investigated. Our aim is toevaluate the prevalence and clinical characteristics of macrovascular diseases,cardiovascular and cerebrovascular events in newly diagnosed Chinese diabetic patientswith ketosis-onset but without islet-associated autoantibodies.Methods: In total,441newly diagnosed Chinese patients with diabetes including39type1diabetcs（IA2-Ab and/or GAD-Ab positive with or without a positive urine ketonebodies）,197ketosis-onset diabetics（IA2-Ab and GAD-Ab negative associated withpositive urine ketone bodies）,205type2diabetics （IA2-Ab and GAD-Ab negativeassociated with ketone negative）and66control subjects without diabetes were studied.Clinical characteristics, biochemical parameters were compared among four groups. Bothcarotid intima-media thickness (CIMT) and carotid atherosclerotic plaques formation andfemoral IMT (FIMT) and lower extremity arterial plaques were assessed and comparedamong the four groups based on Doppler ultrasound examination. The clinical features ofartery atherosclerotic lesions were analysed, and the risk factors associated withatherosclerosis were evaluated using binary logistic regression in patients with diabetes.Result: General clinical features: Male patients (77.6%) in the KODM group wassignificantly more than female patients, while no significant sex differences in the T1DM(56.4%male patients) and T2DM groups (58.5%male patients). Compared with Type2diabetics（56±14years old）, there were earlier age of onset than in the patients withketosis-onset diabetes（49±15years old, p<0.001）; And they have higher HbA1c levels(11.76±1.97%and9.82±2.61%, respectively，P<0.001）, lower fasting plasma C-peptide levels（1.21（0.71-1.93）ng/ml and2.01（1.25-2.93）ng/ml, respectively，P<0.001）and2h postprandial C-Peptide levels（2.22（1.48-3.65）ng/ml and4.61（3.03-6.34）ng/ml,respectively，P<0.001）.Carotid atherosclerotic lesions: After adjusting for age and sex, the prevalence ofcarotid artery plaques had no significant difference between the KODM (33.0%) and thecontrol group (25.8%, p=0.663), and the T1DM group (33.3%, p=0.382), and the T2DMgroup (34.6%, p=0.460). The CIMT value of the ketosis-onset diabetics (0.77±0.21mm)was markedly higher than that of the control subjects (0.70±0.17mm, p=0.020), but nosignificant difference was found compared with the type1diabetics (0.76±0.21mm,p=0.148) and the non-ketotic type2diabetics (0.80±0.20mm,p=0.549) after controlling fordifferences in age and sex.Lower limb atherosclerotic lesions: After adjusting for age and sex, the prevalence oflower extremity arterial plaques (48.7%) in the KODM was significantly higher than thatof the control group (24.1%, p=0.002) and the T1DM group (43.6%, p=0.002), butsignificantly lower than that of the T2DM group (62%, p=0.027). The FIMT value of theketosis-onset diabetics (0.74±0.18mm) was markedly higher than that of the controlsubjects (0.68±0.12mm, p=0.011), but no significant difference was found compared withthe type1diabetics (0.73±0.17mm, p=0.154) and the non-ketotic type2diabetics(0.79±0.22mm, p=0.719) after controlling for differences in age and sex.In the ketosis-onset diabetes, the prevalence of carotid and lower extremity arterialplaques, CIMT and FIMT were markedly increased with age (p<0.001) after controllingfor sex, but no sex difference was observed after controlling for age. In the ketosis-onsetdiabetics, the presence of carotid atherosclerosis was significantly associated with age andmean FIMT.Cardiovascular and cerebrovascular events: The prevalence of cardiovascular andcerebrovascular events was not significantly different in between the newly diagnosedketosis-onset diabetic group (5.6%) and the control group (3.03%, p=0.168), and the type1diabetes groups (2.6%,p=0.265) and the type2diabetes group(13.2%,p=0.149) afteradjusting for age-and sex-related differences. Carotid atherosclerosis was a predictor ofcardiovascular and cerebrovascular events in the patients with KODM.Conclusion: Unlike cases of typical type1and type2diabetes, which display asimilar sex distribution, ketosis-onset diabetes shows a stronger prevalence in males. The patients with ketosis-onset diabetes showed an earlier onset, with a mean age of49yearsconsidering that the mean age of the patients with non-ketotic type2diabetes was56yearsold. They had a higher blood glucose level and lower plasma C-peptide levels. Theprevalence of atherosclerosis and IMT values were increased with age, but had no sexdifference in the KODM.Carotid atherosclerosis was a predictor of cardiovascular andcerebrovascular events in the patients with KODM. The prevalence and risk ofatherosclerosis were significantly higher in the ketosis-onset diabetics than in the controlsubjects but similar to that in the non-ketotic type2diabetics. Based on diabeticmacrovascular diseases, our findings support the classification of ketosis-onset diabetes asa subtype of type2diabetes.