title: HbA1cas a Screening tool for Ketosis in Patients with Type 2 Diabetes Mellitus.
abstract: Ketosis in patients with type 2 diabetes mellitus (T2DM) is overlooked due to atypical symptoms. The objective of this study is to evaluate the value of hemoglobin A1c(HbA1c) as a screening tool for ketosis in T2DM patients. This retrospective study consisted of 253 T2DM patients with ketosis at Shanghai 10th People's Hospital during a period from January 1, 2011 to June 30, 2015. A control group consisted of 221 T2DM patients without ketosis randomly selected from inpatients during the same period. Receiver operating characteristic curve (ROC) analysis was used to examine the sensitivity and specificity of HbA1cas an indicator for ketosis. Higher HbA1clevels were correlated with ketosis. In patients with newly diagnosed T2DM, the area under the curve (AUC) was 0.832, with 95% confidence interval (CI) 0.754-0.911. The optimal threshold was 10.1% (87 mmol/mol). In patients with previously diagnosed T2DM, the AUC was 0.811 (95% CI: 0.767-0.856), with an optimal threshold of 8.6% (70 mmol/mol). HbA1cis a potential screening tool for ketosis in patients with T2DM. Ketosis is much more likely with HbA1cvalues at ≥10.1% in patients with newly diagnosed T2DM and HbA1cvalues at ≥8.6% in patients with previously diagnosed T2DM.
authors.affiliation: Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Zhu
authors.affiliation: Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
authors.forename: Le
authors.initials: L
authors.lastname: Bu
authors.affiliation: Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
authors.forename: Manna
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Neurology and Neuroscience, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, United States of America.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Gusdon
authors.affiliation: Heart, Lung and Blood Vessel Center, Tongji University, Shanghai, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Zheng
authors.affiliation: Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
authors.forename: Sharvan
authors.initials: S
authors.lastname: Rampersad
authors.affiliation: Heart, Lung and Blood Vessel Center, Tongji University, Shanghai, China.
authors.forename: Jue
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.|Department of Endocrinology, School of Medicine, Nanjing Medical University, Nanjing, China.
authors.forename: Shen
authors.initials: S
authors.lastname: Qu
mesh_terms: D000328:Adult; D000368:Aged; D000886:Anthropometry; D019540:Area Under Curve; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D003937:Diagnosis, Differential; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007662:Ketosis / Q000097:blood* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012372:ROC Curve; D012044:Regression Analysis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin