Objective  To explore the risk factors of ketosis onset in patients with newly diagnosed type 2 diabetes mellitus (T2DM), and to build a prediction model.

Methods  205 newly diagnosed T2DM patients hospitalized in the department of endocrinology of Wenzhou People's Hospital from January 2017 to June 2022 were enrolled and divided into the simple onset group (n=125) and the ketosis onset group (n=80) according to ketosis onset or not. The clinical characteristics of the two groups of patients were compared. Logistics regression was used to analyze the risk factors of ketosis. A prediction model was established and the receiver operator characteristic (ROC) curve was used to evaluate its predictive value of the onset of ketosis in newly diagnosed T2DM patients.

Results  Compared with the simple onset group, patients in the ketosis onset group were more likely to be male (P=0.009), younger (P<0.001), lower systolic blood pressure (P=0.003), high density lipoprotein (HDL) (P=0.001), fasting and 2 h C peptide levels (P<0.001), thyroid-stimulation hormone (TSH) (P=0.003 ), free triiodothyronine (FT3) (P=0.012), higher loss of weight after the onset (P<0.001), higher glycosylated hemoglobin (HbA1c) (P<0.001), homeostasis model of assessment for insulin resistance index (HOMA-IR) (P<0.001). The multivariate Logistics regression results showed that age, HDL, fasting C peptide level, and TSH were independent protective factors for the development of ketosis, and HbA1c and HOMA-IR were independent risk factors. According to the results of multivariate Logistics regression analysis, the ketosis prediction model of newly diagnosed T2DM patients was established. The AUC of this model was 0.880 (95%CI 0.832 to 0.928, P<0.001). The specificity was 80.8% and the sensitivity was 86.3%. The ROC curve results showed that the ketosis prediction model can better predict the occurrence of ketosis in newly diagnosed T2DM patients compared with the independent indicator.

Conclusion  Age, HDL, fasting C peptide level, and TSH are independent protective factors for the development of ketosis in newly diagnosed T2DM patients, HbA1c and HOMA-IR are independent risk factors, and the predictive model of ketosis has a good predictive effect on the occurrence of ketosis tendency.

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