Prevalence and clinical characteristics of lower limb atherosclerotic lesions in newly diagnosed patients with ketosis-onset diabetes: a cross-sectional study

Abstract

Background: The clinical features of atherosclerotic lesions in ketosis-onset diabetes are largely absent. We aimed to compare the characteristics of lower limb atherosclerotic lesions among type 1, ketosis-onset and non-ketotic type 2 diabetes.

Methods: A cross-sectional study was performed in newly diagnosed Chinese patients with diabetes, including 53 type 1 diabetics with positive islet-associated autoantibodies, 208 ketosis-onset diabetics without islet-associated autoantibodies, and 215 non-ketotic type 2 diabetics. Sixty-two subjects without diabetes were used as control. Femoral intima-media thickness (FIMT), lower limb atherosclerotic plaque and stenosis were evaluated and compared among the four groups based on ultrasonography. The risk factors associated with lower limb atherosclerotic plaque were evaluated via binary logistic regression in patients with diabetes.

Results: After adjusting for age and sex, the prevalence of lower limb plaque in the patients with ketosis-onset diabetes (47.6%) was significantly higher than in the control subjects (25.8%, p = 0.013), and showed a higher trend compared with the patients with type 1 diabetes (39.6%, p = 0.072), but no difference was observed in comparison to the patients with non-ketotic type 2 diabetes (62.3%, p = 0.859). The mean FIMT in the ketosis-onset diabetics (0.73 ± 0.17 mm) was markedly greater than that in the control subjects (0.69 ± 0.13 mm, p = 0.045) after controlling for age and sex, but no significant differences were found between the ketosis-onset diabetics and the type 1 diabetics (0.71 ± 0.16 mm, p = 0.373), and the non-ketotic type 2 diabetics (0.80 ± 0.22 mm, p = 0.280), respectively. Age and FIMT were independent risk factors for the presence of lower limb plaque in both the ketosis-onset and non-ketotic type 2 diabetic patients, while sex and age in the type 1 diabetic patients.

Conclusions: The prevalence and risk of lower limb atherosclerotic plaque in the ketosis-onset diabetes were remarkably higher than in the control subjects without diabetes. The features and risk factors of lower limb atherosclerotic lesions in the ketosis-onset diabetes resembled those in the non-ketotic type 2 diabetes, but different from those in the type 1 diabetes. Our findings provide further evidences to support the classification of ketosis-onset diabetes as a subtype of type 2 diabetes rather than idiopathic type 1 diabetes.

Keywords: Atherosclerosis; Ketosis-onset diabetes; Lower limb arteries; Type 1 diabetes; Type 2 diabetes.

Figure 1

Comparison of lower limb atherosclerotic lesions among the four groups after adjusting for age and sex. (A) Comparison of the prevalence of lower limb atherosclerotic plaque among the four groups. The p-value for four group comparisons was 0.013. (B) Odd ratio of lower limb atherosclerotic plaque for the type 1, ketosis-onset and non-ketotic type 2 diabetic subjects in comparison to control subjects without diabetes. The bars represent the 95% confidence interval. Compared with control subjects, where *p = 0.002 and **p = 0.041. (C) Comparison of the prevalence of lower limb stenosis among the four groups. The p-value for four group comparisons was 0.167. (D) Comparison of the mean FIMT among the four groups. The p-value for four group comparisons was 0.015.

Figure 2

Comparison of lower limb atherosclerotic lesions stratified by sex and age in diabetics. (A) The prevalence of lower limb atherosclerotic plaque stratified by sex in the type 1, ketosis-onset and non-ketotic type 2 diabetic subjects after adjusting for age. (B) The prevalence of lower limb atherosclerotic plaque stratified by age in the type 1, ketosis-onset and non-ketotic type 2 diabetic subjects after adjusting for sex. The p-values for group comparisons were successively 0.001, <0.001 and <0.001 in the type 1 diabetic subjects, ketosis-onset and non-ketotic type 2 diabetic subjects. (C) The prevalence of lower limb stenosis stratified by sex in the type 1, ketosis-onset and non-ketotic type 2 diabetic subjects after adjusting for age. (D) The prevalence of lower limb stenosis stratified by age in the type 1, ketosis-onset and non-ketotic type 2 diabetic subjects for sex. The p-values for group comparisons were 0.001 and <0.001 in the ketosis-onset and non-ketotic type 2 diabetic subjects, respectively. (E) Comparison of mean FIMT stratified by sex in the type 1, ketosis-onset and non-ketotic type 2 diabetic subjects after adjusting for age. (F) Comparison of mean FIMT stratified by age in the type 1, ketosis-onset and non-ketotic type 2 diabetic subjects after adjusting for sex. The p-values for group comparisons were all <0.001 in type 1 diabetic subjects and ketosis-onset and non-ketotic type 2 diabetic subjects.

Figure 3

Comparison of the mean FIMT in subjects with and without lower limb atherosclerotic plaque in each diabetic group.