title: 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.
authors.affiliation: Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China.
authors.forename: Mei-Fang
authors.initials: MF
authors.lastname: Li
authors.affiliation: Department of VIP, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Ren
authors.affiliation: Department of VIP, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China.
authors.forename: Cui-Chun
authors.initials: CC
authors.lastname: Zhao
authors.affiliation: Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Zhang
authors.affiliation: Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China.
authors.forename: Lian-Xi
authors.initials: LX
authors.lastname: Li
authors.affiliation: Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Liu
authors.affiliation: Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China.
authors.forename: Jun-Xi
authors.initials: JX
authors.lastname: Lu
authors.affiliation: Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China.
authors.forename: Yin-Fang
authors.initials: YF
authors.lastname: Tu
authors.affiliation: Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China.
authors.forename: Wei-Jing
authors.initials: WJ
authors.lastname: Zhao
authors.affiliation: Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China.
authors.forename: Yu-Qian
authors.initials: YQ
authors.lastname: Bao
authors.affiliation: Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes; Shanghai key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai 200233, China.
authors.forename: Wei-Ping
authors.initials: WP
authors.lastname: Jia
keywords: Atherosclerosis; Ketosis-onset diabetes; Lower limb arteries; Type 1 diabetes; Type 2 diabetes