Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, China.
Cardiovasc Diabetol. 2013 Jan 16;12:18. doi: 10.1186/1475-2840-12-18.
The features of carotid atherosclerosis in ketosis-onset diabetes have not been investigated. Our aim was to evaluate the prevalence and clinical characteristics of carotid atherosclerosis in newly diagnosed Chinese diabetic patients with ketosis but without islet-associated autoantibodies.
In total, 423 newly diagnosed Chinese patients with diabetes including 208 ketosis-onset diabetics without islet-associated autoantibodies, 215 non-ketotic type 2 diabetics and 79 control subjects without diabetes were studied. Carotid atherosclerosis was defined as the presence of atherosclerotic plaques in any of the carotid vessel segments. Carotid intima-media thickness (CIMT), carotid atherosclerotic plaque formation and stenosis were assessed and compared among the three groups based on Doppler ultrasound examination. The clinical features of carotid atherosclerotic lesions were analysed, and the risk factors associated with carotid atherosclerosis were evaluated using binary logistic regression in patients with diabetes.
The prevalence of carotid atherosclerosis was significantly higher in the ketosis-onset diabetic group (30.80%) than in the control group (15.2%, p=0.020) after adjusting for age- and sex-related differences, but no significant difference was observed in comparison to the non-ketotic diabetic group (35.8%, p=0.487). The mean CIMT of the ketosis-onset diabetics (0.70±0.20 mm) was markedly higher than that of the control subjects (0.57±0.08 mm, p<0.001), but no significant difference was found compared with the non-ketotic type 2 diabetics (0.73±0.19 mm, p=0.582) after controlling for differences in age and sex. In both the ketosis-onset and the non-ketotic diabetes, the prevalence of carotid atherosclerosis was markedly increased with age (both p<0.001) after controlling for sex, but no sex difference was observed (p=0.479 and p=0.707, respectively) after controlling for age. In the ketosis-onset diabetics, the presence of carotid atherosclerosis was significantly associated with age, hypertension, low-density lipoprotein cholesterol and mean CIMT.
The prevalence and risk of carotid atherosclerosis were significantly higher in the ketosis-onset diabetics than in the control subjects but similar to that in the non-ketotic type 2 diabetics. The characteristics of carotid atherosclerotic lesions in the ketosis-onset diabetics resembled those in the non-ketotic type 2 diabetics. Our findings support the classification of ketosis-onset diabetes as a subtype of type 2 diabetes.
酮症起始型糖尿病患者的颈动脉粥样硬化特征尚未得到研究。我们的目的是评估新诊断的中国糖尿病酮症患者中，无胰岛相关自身抗体的患者颈动脉粥样硬化的患病率和临床特征。
共纳入 423 名新诊断的中国糖尿病患者，包括 208 名无胰岛相关自身抗体的酮症起始型糖尿病患者、215 名非酮症 2 型糖尿病患者和 79 名无糖尿病的对照组。根据多普勒超声检查，将颈动脉粥样硬化定义为任何颈动脉节段存在粥样硬化斑块。比较三组之间的颈动脉内中膜厚度（CIMT）、颈动脉粥样硬化斑块形成和狭窄。分析颈动脉粥样硬化病变的临床特征，并使用二元逻辑回归评估糖尿病患者与颈动脉粥样硬化相关的危险因素。
调整年龄和性别相关差异后，酮症起始型糖尿病组（30.80%）的颈动脉粥样硬化患病率明显高于对照组（15.2%，p=0.020），但与非酮症 2 型糖尿病组（35.8%，p=0.487）无显著差异。酮症起始型糖尿病患者的平均 CIMT（0.70±0.20mm）明显高于对照组（0.57±0.08mm，p<0.001），但与非酮症 2 型糖尿病患者（0.73±0.19mm，p=0.582）相比，在控制年龄和性别差异后无显著差异。在酮症起始型和非酮症糖尿病中，颈动脉粥样硬化的患病率随着年龄的增加而显著增加（均 p<0.001），但在控制性别后，性别差异无统计学意义（分别为 p=0.479 和 p=0.707）。在酮症起始型糖尿病患者中，颈动脉粥样硬化的存在与年龄、高血压、低密度脂蛋白胆固醇和平均 CIMT 显著相关。
与对照组相比，酮症起始型糖尿病患者的颈动脉粥样硬化患病率和风险显著更高，但与非酮症 2 型糖尿病患者相似。酮症起始型糖尿病患者的颈动脉粥样硬化病变特征与非酮症 2 型糖尿病患者相似。我们的研究结果支持将酮症起始型糖尿病分类为 2 型糖尿病的一个亚型。
