Clinical and Epidemiological Characteristics of Diabetic Ketoacidosis in Older Adults

Abstract

OBJECTIVES Much of the research previously done on diabetic ketoacidosis (DKA) was based on a young population with type 1 diabetes mellitus (type 1 DM). But substantial numbers of DKA episodes occur in patients with a prior history of type 2 diabetes mellitus (type 2 DM). There is a lack of Data are lacking about DKA in older adults. The aims of this study were to analyze the clinical characteristics and outcomes of older adult patients with DKA. DESIGN Retrospective matched cohort study of adult patients hospitalized with DKA between 2004 and 2017. SETTING Soroka University Medical Center, Be'er Sheva, Israel. PARTICIPANTS The clinical characteristics of DKA patients 65 years and older were compared with patients younger than 65 years. MEASUREMENTS The primary outcome was in‐hospital mortality. RESULTS The study cohort included 385 consecutive patients for whom the admission diagnosis was DKA: 307 patients (79.7%) younger than 65 years (group 1), and 78 patients (20.3%) older than 65 years (group 2). Patients in group 2 compared with group 1 had a significantly higher Charlson index (6 [6–6] vs 6 [6–7]; P < .0001) and DM with target organ damage (24.4% vs 6.2%; P < .0001). Patients in group 2 compared with group 1 had more serious disease according to results of laboratory investigations. The total in‐hospital mortality rate of patients in group 2 was 16.7% compared with 1.6% in patients in group 1 in a sex and co‐morbidities matched analysis (P = .001). CONCLUSIONS DKA in older adults is a common problem. The serious co‐morbidities and precipitating factors such as infection/sepsis, myocardial infarction, and cerebrovascular accidents, may explain the severity of the problem of DKA in older adults and the high rate of mortality of these patients. DKA appears to be a lifethreatening condition in older adults. The alertness of physicians to DKA in older adults, timely diagnosis, proper treatment, and prevention are cornerstones of care. J Am Geriatr Soc 68:1256–1261, 2020.

Lifetime risk and health-care burden of diabetic ketoacidosis: A population-based study

“…Previous studies identified risk factors for DKA such as lack of adherence to therapy, low socioeconomic status, substance abuse, and low education ( 12 ). It has been shown that in patients with type 2 diabetes DKA is more severe with worse outcomes and higher mortality ( 36 , 37 ).…”

Diabetic Ketoacidosis and COVID-19: A Case Series From an Inner-City Community Teaching Hospital in New York

“…DKA is a life-threatening complication of diabetes mellitus more commonly seen in those with type 1 diabetes mellitus (T1DM), whereas hyperosmolar hyperglycemic syndrome (HHS) is more common in those with T2DM. Nevertheless, there are substantial data on patients with T2DM presenting with DKA episodes [7]. Both can be triggered by infection and can present with severe hyperglycemia, dehydration, and altered mental status.…”

“…DKA in older adults is associated with increased hospital and 30-day mortality [7]. Factors such as age >65 years, presence of fever in the first 24 hours, pH <7.2, and bicarbonate <15 mmol/L have been previously associated with increased mortality in patients with DKA [17].…”

Effectiveness and safety of early insulin glargine administration in combination with continuous intravenous insulin infusion in the management of diabetic ketoacidosis: A randomized controlled trial

“…In Thailand, the annual incidence of DKA increased from 2.29% in 2006 to 6.22% in 2010, and up to 86.7% of the cases had type 2 diabetes 7,8 . Management of DKA in type 2 diabetes can be more complicated because of insulin resistance, older age and co‐existing multiple co‐morbidities 9,10 …”

“…7,8 Management of DKA in type 2 diabetes can be more complicated because of insulin resistance, older age and co-existing multiple co-morbidities. 9,10 Most insulin management protocols in DKA recommend the administration of continuous intravenous (IV) infusion of regular insulin until the resolution of DKA. 1 When oral intake is tolerated, the transition to basal-bolus subcutaneous (SC) insulin therapy can be started.…”