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Changes in circulating adiponectin, leptin, glucose and C-peptide in patients with ketosis-prone diabetes.
Diabet Med. 2015 May; 32(5):692-700.DM

Abstract

AIMS

To evaluate circulating adipokines in people with ketosis-prone diabetes, a heterogeneous disorder characterized by unprovoked ketoacidosis in people with previously unrecognized diabetes.

METHODS

Patients presenting with ketoacidosis with no previous diabetes diagnosis were compared with patients with previously established Type 1 diabetes. Baseline assessments of autoimmune status (A+/A-), and β-cell function (B+/B-), as well as leptin and adiponectin levels during a standardized mixed-meal tolerance test of 120 min, were performed. In all, 20 patients with heterogeneous ketosis-prone diabetes and 12 patients with Type 1 diabetes were evaluated at baseline, 12 and 24 months.

RESULTS

At baseline, during a mixed-meal tolerance test, glucose and adiponectin concentrations were lower in patients with ketosis-prone diabetes than in those with Type 1 diabetes (P = 0.0023 and P < 0.0001, respectively), whereas C-peptide concentrations were higher, with no significant difference in leptin concentrations. Within 12 months, 11 patients with ketosis-prone diabetes (all A-/B+) were discontinued from insulin treatment (ketosis-prone diabetes - insulin group), while nine patients (four A-B-, four A+B- and one A-B+) were maintained on insulin (ketosis-prone diabetes + insulin group). Fasting C-peptide levels increased significantly over 24 months in the ketosis-prone diabetes - insulin group (P = 0.01), while HbA1c levels decreased (P < 0.0001). Overall, the ketosis-prone diabetes - insulin group had a higher BMI (P = 0.018), yet a lower fasting glucose concentration (P = 0.003) compared with the ketosis-prone diabetes + insulin group. Over 24 months, the mixed-meal tolerance test area-under-the-curve of C-peptide increased in the ketosis-prone diabetes - insulin group, with no change in ketosis-prone diabetes + insulin (P < 0.0001). At 24 months, in spite of the higher BMI in the ketosis-prone diabetes - insulin group, mixed-meal tolerance test glucose and leptin concentrations were significantly lower (P < 0.0001 and P = 0.017, respectively), while adiponectin levels were higher (P = 0.023) compared with the ketosis-prone diabetes + insulin group.

CONCLUSIONS

In spite of the higher BMI in the ketosis-prone diabetes - insulin group, lower leptin and higher adiponectin levels may contribute to improved β-cell function and insulin sensitivity, as evidenced by lower glucose and higher C-peptide levels. This allows insulin therapy to be withdrawn.

Authors+Show Affiliations

Centre de Recherche de l'Institut Universitaire de Cardiologie & Pneumologie de Québec, Université Laval, Québec, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25407468

Citation

Gupta, P, et al. "Changes in Circulating Adiponectin, Leptin, Glucose and C-peptide in Patients With Ketosis-prone Diabetes." Diabetic Medicine : a Journal of the British Diabetic Association, vol. 32, no. 5, 2015, pp. 692-700.
Gupta P, Liu Y, Lapointe M, et al. Changes in circulating adiponectin, leptin, glucose and C-peptide in patients with ketosis-prone diabetes. Diabet Med. 2015;32(5):692-700.
Gupta, P., Liu, Y., Lapointe, M., Yotsapon, T., Sarat, S., & Cianflone, K. (2015). Changes in circulating adiponectin, leptin, glucose and C-peptide in patients with ketosis-prone diabetes. Diabetic Medicine : a Journal of the British Diabetic Association, 32(5), 692-700. https://doi.org/10.1111/dme.12638
Gupta P, et al. Changes in Circulating Adiponectin, Leptin, Glucose and C-peptide in Patients With Ketosis-prone Diabetes. Diabet Med. 2015;32(5):692-700. PubMed PMID: 25407468.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Changes in circulating adiponectin, leptin, glucose and C-peptide in patients with ketosis-prone diabetes. AU - Gupta,P, AU - Liu,Y, AU - Lapointe,M, AU - Yotsapon,T, AU - Sarat,S, AU - Cianflone,K, Y1 - 2014/12/17/ PY - 2014/11/17/accepted PY - 2014/11/20/entrez PY - 2014/11/20/pubmed PY - 2016/2/13/medline SP - 692 EP - 700 JF - Diabetic medicine : a journal of the British Diabetic Association JO - Diabet Med VL - 32 IS - 5 N2 - AIMS: To evaluate circulating adipokines in people with ketosis-prone diabetes, a heterogeneous disorder characterized by unprovoked ketoacidosis in people with previously unrecognized diabetes. METHODS: Patients presenting with ketoacidosis with no previous diabetes diagnosis were compared with patients with previously established Type 1 diabetes. Baseline assessments of autoimmune status (A+/A-), and β-cell function (B+/B-), as well as leptin and adiponectin levels during a standardized mixed-meal tolerance test of 120 min, were performed. In all, 20 patients with heterogeneous ketosis-prone diabetes and 12 patients with Type 1 diabetes were evaluated at baseline, 12 and 24 months. RESULTS: At baseline, during a mixed-meal tolerance test, glucose and adiponectin concentrations were lower in patients with ketosis-prone diabetes than in those with Type 1 diabetes (P = 0.0023 and P < 0.0001, respectively), whereas C-peptide concentrations were higher, with no significant difference in leptin concentrations. Within 12 months, 11 patients with ketosis-prone diabetes (all A-/B+) were discontinued from insulin treatment (ketosis-prone diabetes - insulin group), while nine patients (four A-B-, four A+B- and one A-B+) were maintained on insulin (ketosis-prone diabetes + insulin group). Fasting C-peptide levels increased significantly over 24 months in the ketosis-prone diabetes - insulin group (P = 0.01), while HbA1c levels decreased (P < 0.0001). Overall, the ketosis-prone diabetes - insulin group had a higher BMI (P = 0.018), yet a lower fasting glucose concentration (P = 0.003) compared with the ketosis-prone diabetes + insulin group. Over 24 months, the mixed-meal tolerance test area-under-the-curve of C-peptide increased in the ketosis-prone diabetes - insulin group, with no change in ketosis-prone diabetes + insulin (P < 0.0001). At 24 months, in spite of the higher BMI in the ketosis-prone diabetes - insulin group, mixed-meal tolerance test glucose and leptin concentrations were significantly lower (P < 0.0001 and P = 0.017, respectively), while adiponectin levels were higher (P = 0.023) compared with the ketosis-prone diabetes + insulin group. CONCLUSIONS: In spite of the higher BMI in the ketosis-prone diabetes - insulin group, lower leptin and higher adiponectin levels may contribute to improved β-cell function and insulin sensitivity, as evidenced by lower glucose and higher C-peptide levels. This allows insulin therapy to be withdrawn. SN - 1464-5491 UR - https://www.unboundmedicine.com/medline/citation/25407468/Changes_in_circulating_adiponectin_leptin_glucose_and_C_peptide_in_patients_with_ketosis_prone_diabetes_ L2 - https://doi.org/10.1111/dme.12638 DB - PRIME DP - Unbound Medicine ER -