?-hydroxybutyrate as a biomarker of ?-cell function in new-onset type 2 diabetes and its association with treatment response at 6 months

Aims: Increasing attention has been paid to the potential metabolic benefits of ketone bodies, but the clinical relevance of ketone bodies in newly diagnosed type 2 diabetes mellitus (T2D) remains unclear. We investi-gated the clinical implications of ketone bodies at the time of diagnosis in patients with drug-naive T2D.Methods: Clinical data including serum ,B-hydroxybutyrate (,BHB) levels, were collected from 369 patients with newly diagnosed drug-naive T2D from 2017 to 2021. Subjects were categorized into four ,BHB groups based on the level of initial serum ,BHB. The associations of initial serum ,BHB and urinary ketone levels with glucometabolic indices were analyzed.Results: Higher serum ,BHB group was associated with higher levels of glycemic parameters including gly-cated hemoglobin (HbA1c) with lower levels of indices for insulin secretory function at the point of initial diagnosis of T2D. Nevertheless, higher serum ,BHB group was an independent determinant of a greater rela-tive improvement in HbA1c after 6 months of anti-diabetic treatment, regardless of the type of anti-diabetic drug. In addition, patients in higher serum ,BHB group were more likely to have well-controlled HbA1c levels (<= 6.5%) after 6 months of anti-diabetic treatment.Conclusion: In patients with newly diagnosed T2D, a higher initial ,BHB level was a significant predictive marker of greater glycemic improvement after antidiabetic treatment, despite its associations with hypergly-cemia and decreased insulin secretion at baseline.(c) 2023 Elsevier Masson SAS. All rights reserved.