Ketosis more likely in type 2 diabetes with elevated osteocalcin levels
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Adults with type 2 diabetes and lower levels of osteocalcin may be more likely to experience ketosis compared with those with higher levels, according to findings published in Diabetes/Metabolism Research and Reviews.
“Our study provides the first evidence that there is a significant inverse dose-response association between total osteocalcin level and risk of ketosis in type 2 diabetes,” Shen Qu, PhD, MD, of the department of endocrinology and metabolism at Shanghai Tenth People’s Hospital and Tongji University School of Medicine in Shanghai, and colleagues wrote. “These results provide a practical marker to predict ketosis in type 2 diabetes and also add novel insights into the crosstalk between the hormonal control of bone and ketogenesis.”
Qu and colleagues used medical records from Shanghai Tenth People’s Hospital to compare osteocalcin levels for 304 adults with type 2 diabetes and ketosis (mean age, 55 years; 31.9% women) and 304 matched adults with type 2 diabetes and no ketosis (mean age, 56 years; 31.9% women). The researchers further assessed blood ketones, urine ketones and osteocalcin levels across a follow-up period of 21.58 months among 252 adults with type 2 diabetes and no ketosis in the initial study.
The average osteocalcin level was 8.8 ng/mL for those with type 2 diabetes and ketosis compared with 13.1 ng/mL for those without ketosis (P < .001). The researchers noted that there was a negative correlation between osteocalcin and urine ketones (P = .001) and blood ketones (P = .004) even after adjustments.
In fully adjusted models, participants with less than 7.28 ng/mL of osteocalcin were 23.81 times more likely to experience ketosis compared with those with more than 15.65 ng/mL of osteocalcin (95%, 4.32-131.17). Participants with between 7.28 ng/mL and 9.95 ng/mL (OR = 10.77; 95% CI, 2.63-44.15), between 9.95 ng/mL and 12.47 ng/mL (OR = 3.71; 95% CI, 0.9-15.29) and between 12.47 ng/mL and 15.65 ng/mL (OR = 2.56; 95% CI, 0.8-8.17) were also more likely to experience ketosis than those with more than 15.65 ng/mL.
Among the participants without ketosis in the initial analysis, 17 later experienced the condition, according to the researchers, who observed a mean osteocalcin level of 9.43 ng/mL among this group compared with 13.39 ng/mL among those who did not experience ketosis (P = .005).
The researchers identified 11.68 ng/mL of osteocalcin as the “threshold for predicting ketosis” based on receiver operating characteristic curve analysis. The researchers further noted that 14% of those with ketosis had osteocalcin levels below this threshold while 2.5% of those without ketosis had levels above the threshold. In addition, 76.5% of those with ketosis were below the threshold and 34% of those without ketosis were above it (P < .001).
“Total osteocalcin could be used as a potential tool to predict the risk of developing ketosis in type 2 diabetes patients,” the researchers wrote. “Further, larger prospective studies are merited to explore the predictive power of osteocalcin in type 2 diabetes and verify the optimal threshold value.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.
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