The value of serum creatinine-to-cystatin C ratio in newly diagnosed ketosis-prone diabetes

Purpose Ketosis-prone diabetes (KPD) is a new subtype of diabetes distinct from traditional type 2 diabetes, and the role of muscle mass in KPD remains unclear. Serum creatinine-to-cystatin C ratio (CCR) has been identified as a marker of muscle mass. The present study aims to investigate the value of CCR in newly diagnosed KPD. Methods 290 newly diagnosed T2D included into the study were divided into T2D (n=195) and KPD (n=95) group according to the occurrence of ketosis. The cutoff value of CCR in identifying KPD was analyzed by receiver operating characteristic (ROC) curve. Logistic regression was used to assess the relationship between CCR and KPD and the independent influences on KPD. Results The serum CCR level of KPD group was significantly higher than that of T2D group. After adjustment for all confounders, the risk of KPD was significantly increased with elevated CCR levels. The optimal cutoff value for CCR were 69.775 for male and 63.365 for female, with areas under the ROC curves of 0.639 in male and 0.648 in female. Postprandial blood glucose and CCR were independent risk factors, whereas age and postprandial C-peptide were independent protective factors for the KPD. Conclusion High levels of CCR are significantly associated with the odds of KPD, suggesting that higher muscle mass (estimated by CCR) may be linked to higher KPD incidence. Our study suggests that CCR may be a useful marker for the incidence of KPD, providing new insights into the mechanisms of KPD.