Comparisons of biochemical parameters and diabetic ketoacidosis severity in adult patients with type 1 and type 2 diabetes

Abstract

Objective The aim of this study was to determine the differences in biochemical parameters and diabetic ketoacidosis (DKA) severity in adult patients with type 1 and type 2 diabetes and utilization of serum BHB as a biomarker for DKA resolution was also evaluated. Materials and methods This prospective observational study of type 1 or type 2 diabetes mellitus who were diagnosed with DKA between 01 October 2018 and 30 September 2020. The correlations between serum BHB, measured by the Ranbut assay, and pH, bicarbonate, and anion gap were examined. Results A total of 99 diabetes patients were diagnosed with DKA (mean age 39.4 years, 63.4% female, 53.6% T2DM). while infection was the most common precipitating factor in T2DM (43.4%), non-compliance with treatment was the most common precipitating factor in T1DM (43.5%). T1DM patients had more severe DKA more hypokalemia during treatment. However, there was no significant difference in mortality between type1 and type2 diabetes. The initial laboratories evaluation of patients did not significant differ between type1 and type2 diabetes. Serum BHB during treatment of DKA was significantly correlated with changes in serum bicarbonate (r = − 0.64), serum anion gap (r = 0.84), and venous pH (r = − 0.6). The serum BHB levels corresponding to HCO3 levels for DKA severity were 4.5, 5.7, and 5.9 mmol/L in mild, moderate, and severe DKA, respectively. The serum BHB level of < 1 mmol/L had 73.7% sensitivity and 100% specificity to predict DKA resolution. Median time to resolution of DKA was 12 h with an optimized BHB cut-off value of < 1 mmol/L. There were no significant difference in time to resolution of DKA in the patients with type 1 and type 2 diabetes. Conclusions There are no differences in DKA-related biochemical parameters between type 1 and type 2 diabetes patients. The present findings suggest that DKA should be assessed and treated similarly, regardless of its occurrence in type 1 or type 2 diabetes patients.

Empagliflozin-associated postoperative mixed metabolic acidosis. Case report and review of pathogenesis

“…An elevated beta-hydroxybutyrate concentration of 3.2 mmol/l. Corresponded to a mild ketoacidosis [12]. Together with lactate and acetoacetate, whose concentration is about three times lower than that of beta-hydroxybutyrate, [13] the total organic acid concentration was about 10 mmol/l.…”

Empagliflozin-associated postoperative mixed metabolic acidosis. Case report and review of pathogenesis

“…Rather low ketones corresponded with mild DKA. 4 A renal tubular acidosis with a direct loss of bicarbonate could alternatively explain the hyperchloremic acidosis. However, we have found only 3 published cases of pronounced proximal tubule disorder, Fanconi syndrome, during SGLT2i treatment that included renal tubular acidosis with rather low anion gap, [23][24][25] yet all with increased ketone levels.…”

“…An elevated betahydroxybutyrate concentration of 3.2 mmol/l [1] corresponded to mild ketoacidosis. 4 Together with lactate and acetoacetate, whose concentration is about three times less than that of beta-hydroxybutyrate, 5 the total organic acids concentration was about 10 mmol/l. The anion gap was 18.1 mmol/l, i.e.…”

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

“…It is usually precipitated by discontinuation of insulin or inadequate insulin therapy, infection, injury or a serious illness 6 . 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 …”

“…6 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 Most insulin management protocols in DKA recommend the administration of continuous intravenous (IV) infusion of regular insulin until the resolution of DKA.…”