Non-antibody biomarkers for differentiating ketosis-onset diabetes: A retrospective study

doi:10.4239/wjd.122101

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World Journal of Diabetes

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1948-9358

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Diabetes. Aug 15, 2026; 17(8): 122101
Published online Aug 15, 2026. doi: 10.4239/wjd.122101

Table 1 Baseline characteristics and biochemical (ketosis-prone type 2 diabetes mellitus vs type 2 diabetes mellitus), n (%)/median (interquartile rage)/mean ± SD

Parameter	KP-T2DM (n = 146)	T2DM (n = 93)	P value
Male	115 (78.8)	65 (69.2)	< 0.001
Age (years)	32	44 (34-51)	< 0.001
BMI (kg/m²)	25.10 (22.90-28.62)	23.88 (22.49-26.28)	0.037
FPG (mmol/L)	14.37 ± 3.75	12.73 ± 4.13	0.001
HbA1c (%)	12.10 ± 2.21	10.87 ± 2.12	< 0.001
FCP (ng/mL)	0.70 (0.36-0.93)	1.20 (0.61-1.51)	< 0.001
2hCP (ng/mL)	1.67 (1.02-2.02)	2.71 (1.46-3.13)	< 0.001
TG (mmol/L)	2.78 (1.63-5.34)	1.95 (1.23-3.11)	< 0.001
HDL-C (mmol/L)	0.85 (0.75-0.88)	0.91 (0.78-1.00)	0.005
ALP (U/L)	114.5 (87.8-134.7)	86.1 (68.0-97.5)	< 0.001

BMI: Body mass index; FPG: Fasting plasma glucose; HbA1c: Glycated hemoglobin; FCP: Fasting C-peptide; 2hCP: 2 hours C-peptide; TG: Triglycerides; HDL-C: High-density lipoprotein cholesterol; ALP: Alkaline phosphatase; KP: Ketosis-prone; T2DM: Type 2 diabetes mellitus.

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Table 2 Multivariate logistic regression for ketosis onset

Variable	OR	95%CI	P value
Age (per year)	0.954	0.92-0.99	0.016
Weight (per kg)	1.074	1.03-1.12	0.002
FPG (per mmol/L)	1.420	1.24-1.63	< 0.001
FCP (per ng/mL)	0.193	0.07-0.51	< 0.001
FT3 (per pg/mL)	0.118	0.04-0.32	< 0.001
ALP (per U/L)	1.016	1.00-1.03	0.024

FPG: Fasting plasma glucose; FCP: Fasting C-peptide; FT3: Free triiodothyronine; ALP: Alkaline phosphatase; OR: Odds ratio; CI: Confidence interval.

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Table 3 Receiver operating characteristic analysis for predicting ketosis onset in type 2 diabetes mellitus

Variable	AUC	Sensitivity	Specificity	Optimal cut-off	P value
Age (years)	0.71	0.76	0.61	40.50	< 0.001
FPG (mmol/L)	0.81	0.82	0.70	11.12	< 0.001
FT3 (pg/mL)	0.82	0.62	0.91	2.70	< 0.001
ALP (U/L)	0.75	0.75	0.70	89.40	< 0.001

FPG: Fasting plasma glucose; FT3: Free triiodothyronine; ALP: Alkaline phosphatase; AUC: Area under the curve.

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Table 4 Baseline characteristics and biochemical (latent autoimmune diabetes in adult vs ketosis-prone type 2 diabetes mellitus), n (%)/median (interquartile rage)/mean ± SD

Parameter	LADA (n = 55)	KP-T2DM (n = 146)	P value
Male	29 (52.7)	115 (78.8)	< 0.001
Age (years)	32	32	0.772
Weight (kg)	55	75	< 0.001
BMI (kg/m²)	20.20 (18.36-22.14)	25.10 (22.90-28.62)	< 0.001
Systolic BP (mmHg)	114.07 ± 16.55	126.17 ± 16.35	< 0.001
Diastolic BP (mmHg)	74.82 ± 11.39	81.60 ± 12.52	< 0.001
FCP (ng/mL)	0.30 (0.15-0.46)	0.70 (0.36-0.93)	< 0.001
2hCP (ng/mL)	0.64 (0.37-0.80)	1.67 (1.02-2.02)	< 0.001
HOMA-β (C-peptide)	8.10 (3.83-15.99)	15.70 (7.47-28.32)	< 0.001
HOMA-IR (C-peptide)	2.85 (2.23-3.81)	4.47 (3.14-6.24)	< 0.001
TG (mmol/L)	1.64 (1.13-2.62)	2.78 (1.63-5.34)	0.003
HDL-C (mmol/L)	1.04 (0.97-1.08)	0.85 (0.75-0.88)	0.018
LDL-C (mmol/L)	2.60 (2.54-2.60)	2.97 (2.55-3.19)	0.011
ALP (U/L)	100.40 (85.20-119.00)	114.51 (87.75-134.65)	0.047
GGT (U/L)	20.20 (14.80-25.80)	44.65 (22.85-56.15)	< 0.001

BMI: Body mass index; BP: Blood pressure; FCP: Fasting C-peptide; 2hCP: 2 hours C-peptide; HOMA: Homeostasis model assessment; IR: Insulin resistance; TG: Triglycerides; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; ALP: Alkaline phosphatase; GGT: Gamma-glutamyl transferase; LADA: Latent autoimmune diabetes in adult; KP: Ketosis-prone; T2DM: Type 2 diabetes mellitus.

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Table 5 Multivariate logistic regression for latent autoimmune diabetes in adult vs ketosis-prone type 2 diabetes mellitus

Variable	OR	95%CI	P value
2hCP (per ng/mL)	17.89	4.96-64.45	< 0.001
HOMA-IR (C-peptide)	0.68	0.51-0.91	0.010
HDL-C (per mmol/L)	0.00	0.00-0.02	< 0.001
LDL-C (per mmol/L)	2.47	1.16-5.27	0.019
GGT (per U/L)	1.05	1.01-1.09	0.014

2hCP: 2 hours C-peptide; HOMA: Homeostasis model assessment; IR: Insulin resistance; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; GGT: Gamma-glutamyl transferase; OR: Odds ratio; CI: Confidence interval.

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Table 6 Receiver operating characteristic analysis for differentiating latent autoimmune diabetes in adult from ketosis-prone type 2 diabetes mellitus

Variable	AUC	Sensitivity	Specificity	Optimal cut-off	P value
2hCP (ng/mL)	0.85	0.86	0.77	< 0.98	< 0.001
HDL-C (mmol/L)	0.79	0.73	0.86	> 1.03	< 0.001
GGT (U/L)	0.79	0.95	0.56	< 37.85	< 0.001
HOMA-IR (C-peptide)	0.70	0.80	0.61	< 4.01	< 0.001

2hCP: 2 hours C-peptide; HDL-C: High-density lipoprotein cholesterol; GGT: Gamma-glutamyl transferase; HOMA: Homeostasis model assessment; IR: Insulin resistance; AUC: Area under the curve.

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Citation: Pei SQ, Ren JL, Zhang L, Gao YX, Yang X, Liu X, Li SN, Liu P, Xu XY. Non-antibody biomarkers for differentiating ketosis-onset diabetes: A retrospective study. World J Diabetes 2026; 17(8): 122101
URL: https://www.wjgnet.com/1948-9358/full/v17/i8/122101.htm
DOI: https://dx.doi.org/10.4239/wjd.122101

Pei SQ, Ren JL, Zhang L, Gao YX, Yang X, Liu X, Li SN, Liu P, Xu XY. Non-antibody biomarkers for differentiating ketosis-onset diabetes: A retrospective study. World J Diabetes 2026; 17(8): 122101 [DOI: 10.4239/wjd.122101]

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