Acylation Stimulating Protein, Complement C3 and Lipid Metabolism in Ketosis-Prone Diabetic Subjects

• Published in: PloS one Vol. 9; no. 10; p. e109237
• Main Authors: Liu, Yan, Gupta, Priyanka, Lapointe, Marc, Yotsapon, Thewjitcharoen, Sarat, Sunthornyothin, Cianflone, Katherine
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 02.10.2014; Public Library of Science (PLoS)
• Subjects: Acylation; Adipocytes; Adipokines - blood; Adipose tissue; Adiposity; Adolescent; Adult; Biology and Life Sciences; Complement C3a - analysis; Complement C3a - metabolism; Complement component C3; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - metabolism; Diabetes therapy; Diabetic Ketoacidosis - blood; Diabetic Ketoacidosis - drug therapy; Diabetic Ketoacidosis - metabolism; Diabetics; Endocrinology; Esterification; Fatty acids; Fatty Acids, Nonesterified - blood; Fatty Acids, Nonesterified - metabolism; Female; Gastrointestinal surgery; Glucose; Humans; Hypoglycemic Agents - therapeutic use; Information technology services; Insulin; Insulin - therapeutic use; Insulin resistance; Ketoacidosis; Lipid Metabolism; Lipids; Male; Medicine; Medicine and Health Sciences; Metabolism; Middle Aged; Obesity; Patients; Physiological aspects; Postprandial Period; Protein turnover; Proteins; Triglycerides; Triglycerides - blood; Triglycerides - metabolism; Young Adult; Thailand; Canada; Bangkok Thailand
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0109237

Ketosis-prone diabetes (KPDM) is new-onset diabetic ketoacidosis without precipitating factors in non-type 1 diabetic patients; after management, some are withdrawn from exogenous insulin, although determining factors remain unclear. Twenty KPDM patients and twelve type 1 diabetic patients (T1DM), evaluated at baseline, 12 and 24 months with/without insulin maintenance underwent a standardized mixed-meal tolerance test (MMTT) for 2 h. At baseline, triglyceride and C3 were higher during MMTT in KPDM vs. T1DM (p<0.0001) with no differences in non-esterified fatty acids (NEFA) while Acylation Stimulating Protein (ASP) tended to be higher. Within 12 months, 11 KPDM were withdrawn from insulin treatment (KPDM-ins), while 9 were maintained (KPDM+ins). NEFA was lower in KPDM-ins vs. KPDM+ins at baseline (p = 0.0006), 12 months (p<0.0001) and 24 months (p<0.0001) during MMTT. NEFA in KPDM-ins decreased over 30-120 minutes (p<0.05), but not in KPDM+ins. Overall, C3 was higher in KPDM-ins vs KPDM+ins at 12 months (p = 0.0081) and 24 months (p = 0.0019), while ASP was lower at baseline (p = 0.0024) and 12 months (p = 0.0281), with a decrease in ASP/C3 ratio. Notwithstanding greater adiposity in KPDM-ins, greater NEFA decreases and lower ASP levels during MMTT suggest better insulin and ASP sensitivity in these patients.