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Diabetologia

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01-05-2019 | Insulins | Article

Spontaneous ketonuria and risk of incident diabetes: a 12 year prospective study

Authors: Gyuri Kim, Sang-Guk Lee, Byung-Wan Lee, Eun Seok Kang, Bong-Soo Cha, Ele Ferrannini, Yong-ho Lee, Nam H. Cho

Published in: Diabetologia | Issue 5/2019

Abstract

Aims/hypothesis

Ketones may be regarded as a thrifty fuel for peripheral tissues, but their clinical prognostic significance remains unclear. We investigated the association between spontaneous fasting ketonuria and incident diabetes in conjunction with changes in metabolic variables in a large population-based observational study.

Methods

We analysed 8703 individuals free of diabetes at baseline enrolled in the Korean Genome and Epidemiology Study, a community-based 12 year prospective study. Individuals with (n = 195) or without fasting ketonuria were matched 1:4 by propensity score. Incident diabetes was defined as fasting plasma glucose ≥7.0 mmol/l, post-load 2 h glucose ≥11.1 mmol/l on biennial OGTTs, or current use of glucose-lowering medication. Using Cox regression models, HRs for developing diabetes associated with the presence of ketonuria at baseline were analysed.

Results

Over 12 years, of the 925 participants in the propensity score-matched cohort, 190 (20.5%) developed diabetes. The incidence rate of diabetes was significantly lower in participants with spontaneous ketonuria compared with those without ketonuria (HR 0.63; 95% CI 0.41, 0.97). Results were virtually identical when participants with fasting ketonuria were compared against all participants without ketonuria (after multivariate adjustment, HR 0.66; 95% CI 0.45, 0.96). During follow-up, participants with baseline ketonuria maintained lower post-load 1 h and 2 h glucose levels and a higher insulinogenic index despite comparable baseline values.

Conclusions/interpretation

The presence of spontaneous fasting ketonuria was significantly associated with a reduced risk of diabetes, independently of metabolic variables. Our findings suggest that spontaneous fasting ketonuria may have a potential preventive role in the development of diabetes.

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Title: Spontaneous ketonuria and risk of incident diabetes: a 12 year prospective study
Authors: Gyuri Kim
Sang-Guk Lee
Byung-Wan Lee
Eun Seok Kang
Bong-Soo Cha
Ele Ferrannini
Yong-ho Lee
Nam H. Cho
Publication date: 01-05-2019
Publisher: Springer Berlin Heidelberg
Keywords: Insulins
Insulins
Published in: Diabetologia / Issue 5/2019
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-019-4829-x

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Spontaneous ketonuria and risk of incident diabetes: a 12 year prospective study

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