Risk Factors of Ketosis in Obese Ketosis-Prone Diabetic Patients: A Case-Control Study

INTRODUCTION: Different types of ketosis-prone obese diabetic patients are seen in the clinic. At present, the mechanism responsible for ketosis onset in these patients remains unclear, and we do not know how these patients should be optimally treated to prevent recurrent ketosis. Therefore, this study aims to investigate risk factors of ketosis in obese ketosis-prone diabetic (OB-KPD) patients. METHODS: In an observational case-control study, primary OB-KPD patients [body mass index (BMI) ≥ 28 kg/m(2)] were selected as the study group (OB-KPD group), and primary obese type 2 diabetes patients served as the control group (OB-T2DM group). Clinical diagnostic assessments of fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), blood lipid, area under curve of serum C-peptide (AUC(C-P)) after steamed bread meal, insulin sensitivity index (ISI), β-hydroxybutyric acid (β-HB) and free fatty acid (FFA) vlaues of the subjects were collected. Subjects in the OB-KPD group were followed up for 1 year to determine the likelihood of insulin therapy cessation and whether ketosis recurred by assessing clinical chemistry parameters at 1-year follow-up. RESULTS: Seventy-five subjects were screened, of which 15 were not included in the study for several identified clinical reasons. On enrollment, the OB-KPD group displayed significantly higher FPG, HbA1c and FFA levels than the OB-T2DM group (p < 0.01), while AUC(C-P) and ISI values were significantly lower than in the OB-T2DM group (p < 0.01 and p = 0.03). Statistical analysis showed that increases in β-HB in the OB-KPD group were associated with increased blood glucose and FFA and decreased AUC(C-P) and ISI values. Furthermore, decreases in AUC(C-P) were closely associated with increased blood glucose values. CONCLUSION: The occurrence of ketosis in ketosis-prone obese diabetic patients may be related to glucose and lipid metabolism disorders, increased insulin resistance and decreased β-cell secretory functions. TRIAL REGISTRATION: This work was registered at the Chinese Clinical Trial Registry with trial registration identifier no. ChiCTR1900025909.