| Objective:Compare the clinical characteristics and chronic complications of diabetes in patients with ketosis-prone type 2 diabetes(KPD),adult latent autoimmune diabetes in adults(LADA)and type 2 diabetes(T2DM),to improve the understanding of different types of diabetes.Methods:A total of 68 newly diagnosed patients with KPD,41 patients with LADA,and 73 patients with T2DM who were hospitalized in the Department of Endocinology of the First Affiliated Hospital of Guangxi Medical University from August 2012 to August 2020 were collected.The medical history,glucose and lipid metabolism,insulin resistance,islet function,chronic complications and complications of diabetes mellitus were compared between the groups.Result:1.Comparison of general information:The average age of onset was about 42.8 years(31.6～54 years)in patients with KPD and 42.3 years(28.6～56.4 years)in patients with LADA,both lower than that in patients with T2DM(52.3 years,P<0.05).The male-to-female ratio of KPD patients was about 4:1,while the male-to-female ratio of LADA patients was equal.About89.7%of KPD patients had symptoms of"three more and one less"at onset,which was similar to LADA patients(87.8%,P>0.05),and higher than T2DM patients(68.5%,P<0.05).The level of systolic blood pressure in patients with KPD was higher than that in patients with LADA(126VS118 mm Hg,P<0.05),and lower than that in patients with T2DM(134 mm Hg,P<0.05).BMI of KPD patients was significantly higher than that of LADA patients(24.76vs20.73kg/m~2,P<0.05),and lower than that of T2DM patients(25.60 kg/m~2,P<0.05).The waist circumference of male patients with KPD was similar to that of T2DM patients(92.1vs93.3 cm,P>0.05),both larger than that of LADA patients(82.8 cm,P<0.05),while the waist circumference of female patients in the three groups was basically the same.2.Comparison of glucose and lipid metabolism,insulin resistance and islet function:The fasting blood glucose and glycosylated hemoglobin of KPD patients were basically similar to those of LADA patients(P>0.05),and they were higher than those of T2DM patients(P<0.05).In terms of lipid metabolism,KPD patients have higher total cholesterol and non-high-density lipoprotein levels than T2DM patients(TC:5.40 vs 5.00 mmol/L,LDL-C:3.39 vs 3.01mmol/L,P<0.05),There was no significant difference between KPD and LADA patients(TC:5.40 vs 5.34 mmol/L,LDL-C:3.39 vs 3.39 mmol/L,P>0.05).The HOMA-IR of KPD patients was higher than that of LADA patients,and the HOMA-IR of both groups were lower than T2DM patients.HOMA-βin KPD patients was higher than that in LADA patients,and HOMA-βin both groups was lower than that in T2DM patients,and the differences were statistically significant.3.Comparison of diabetic complications and comorbidities:The proportion of patients with diabetic macrovascular disease in the three groups was:T2DM(74.6%)>KPD(61.2%)>LADA(43.2%),but the difference was statistically significant only in LADA and T2DM patients.About 70.3%of KPD patients had fatty liver,the proportion was higher than that of LADA patients(21.6%,P<0.05),and the proportion of KPD patients with fatty liver was similar to T2DM.There was no significant difference in the proportions of patients with coronary heart disease,diabetic peripheral neuropathy,and diabetic retinopathy in the three groups(P>0.05).Conclusion:1.Patients with KPD and LADA have basically similar presentation at the onset of disease,while there is a great difference in body shape(such as waist circumference and BMI)between them and LADA patients,which is more similar to T2DM patients.2.There is a large proportion of male patients in KPD,while there is an equal proportion of male and female patients in LADA.3.Insulin resistance and islet function in KPD patients were between LADA patients and T2DM patients.4.The proportions of KPD patients with fatty liver and diabetic macroangiopathy were higher than those of LADA patients.Patients with KPD were similar to those with T2DM in the chronic complications and subsequent treatment of diabetes.5.In our opinion,it is still debatable whether special classification of ketosis-prone type 2 diabetes is needed. |
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