Diabetic ketoacidosis in pregnancy tends to occur at lower blood glucose levels: Case–control study and a case report of euglycemic diabetic ketoacidosis in pregnancy

Guo, Ruixia; Lingzhu, Yang; Li, Liu-xia; Zhao, Xin

doi:10.1111/j.1447-0756.2008.00720.x

Cited by 91 publications

(73 citation statements)

References 24 publications

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“…Specifically, both patients presented with plasma glucose concentrations that could be interpreted as lower than typically associated with diabetic ketoacidosis. Although speculative, increased urinary glucose disposal induced by SGLT2 inhibition may be akin to the disposal observed in fasting, prolonged activity or pregnancy in which lower plasma glucose concentrations have been observed (14,15). The risk of ketosis should be carefully evaluated in future trials.…”

Section: Discussionmentioning

confidence: 99%

Sodium-Glucose Cotransporter 2 Inhibition and Glycemic Control in Type 1 Diabetes: Results of an 8-Week Open-Label Proof-of-Concept Trial

et al. 2014

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OBJECTIVEAdjunctive-to-insulin therapy with sodium-glucose cotransporter 2 (SGLT2) inhibition may improve glycemic control in type 1 diabetes (T1D). RESEARCH DESIGN AND METHODSWe evaluated the glycemic efficacy and safety of empagliflozin 25 mg daily in 40 patients treated for 8 weeks in a single-arm open-label proof-of-concept trial (NCT01392560). RESULTSMean A1C decreased from 8.0 6 0.9% (64 6 10 mmol/mol) to 7.6 6 0.9% (60 6 10 mmol/mol) (P < 0.0001), fasting glucose from 9.0 6 4.3 to 7.0 6 3.2 mmol/L (P = 0.008), symptomatic hypoglycemia (<3.0 mmol/L) from 0.12 to 0.04 events per patient per day (P = 0.0004), and daily insulin dose from 54.7 6 20.4 to 45.8 6 18.8 units/day (P < 0.0001). Mean urinary excretion of glucose increased from 19 6 19 to 134 6 61 g/day (P < 0.0001). Weight decreased from 72.6 6 12.7 to 70.0 6 12.3 kg (P < 0.0001), and waist circumference decreased from 82.9 6 8.7 to 79.1 6 8.0 cm (P < 0.0001). CONCLUSIONSThis proof-of-concept study strongly supports a randomized clinical trial of adjunctive-to-insulin empagliflozin in patients with T1D.

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Section: Discussionmentioning

confidence: 99%

Sodium-Glucose Cotransporter 2 Inhibition and Glycemic Control in Type 1 Diabetes: Results of an 8-Week Open-Label Proof-of-Concept Trial

et al. 2014

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“…Although increasing prenatal care and strict monitoring of pregnancy, DKA is still a serious medical problem because it may be a more common occurrence in pregnant women than non-pregnant women and it can also occur with a relatively low or even normal glucose levels during pregnancy. Guo et al (8), evaluated the incidence of DKA and compared glucose levels at diagnosis of DKA in pregnant and non-pregnant women with diabetes. They found that DKA had a higher incidence in pregnant women with diabetes (8/90, 8.9%) than in non-pregnant women with diabetes (9/286, 3.1%) and the blood glucose levels in pregnant women with DKA were significantly lower than non-pregnant women with DKA (16.3 vs 27.5).…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, normoglycemic DKA during pregnancy is truly unusual but can occur with relatively low, or even normal blood glucose levels (8,9). A variety of hormonal and physical changes during pregnancy increases the tendency for DKA (1,3 ).…”

Section: Introductionmentioning

confidence: 99%

Gebelik sırasında diabetik ketoasidoz: Olgu sunumu ve literatür derlemesi

Akman¹,

Hurşitoğlu²,

Kazandı³

2014

Ege Tıp Dergisi

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SummaryDiabetic ketoacidosis (DKA) is a serious and an acute, metabolic complication of diabetes. It is characterized by the triad of hyperglycemia, metabolic acidosis, and increased ketone body concentration (ketonuria and ketonemia). DKA is a rare complication of diabetic women during pregnancy and it is risky for both mother and fetus. In spite of all treatment, it may result in fetal loss. However, early diagnosis and aggressive treatment of DKA may reduce the level of high perinatal mortality.

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“…DKA in pregnancy (DKP) can complicate type 1 diabetes, type 2 diabetes, or gestational diabetes mellitus (GDM) [4]. The incidence of DKP varies greatly according to the place and period of the concerned study; it ranges from 0.5% [5], the lowest reported rate in western countries, to 8.9% in a study conducted in China [6]. The difference is due to the local patient demography, level of physicians' awareness and patient education regarding DKP.…”

Section: Introductionmentioning

confidence: 99%

“…Deleterious morbidities and mortality may affect both the woman and fetus. Several reports have attempted to determine the characteristics of the clinical presentation of patients with DKP [6,[8][9][10][11]. However, most of these reports are relatively old, with no recent studies from our region in the Middle East.…”

Section: Introductionmentioning

confidence: 99%

Retrospective Analysis of Diabetic Ketoacidosis in Pregnant Women over a Period of 3 Years

Baagar¹,

Aboudi²,

Khaldi³

et al. 2017

Endocrinol Metab Syndr

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Objective: The incidence of diabetic ketoacidosis in pregnancy (DKP) varies from 0.5%, the lowest reported rate in western countries, to 8.9% in a study conducted in China. The associated fetal mortality is 9-36%. This study aimed to assess the current incidence, causes, and outcomes of diabetic ketoacidosis in pregnancy and identify factors associated with favorable outcomes. Methods:A retrospective chart review of 20 diabetic ketoacidosis hospital admissions of 19 pregnant women from 3,679 diabetic pregnancies delivered between June 2012 and May 2015 was conducted. Those with successful DKP management (group A) or with intrauterine fetal death or urgent delivery during diabetic ketoacidosis management (group B) were compared.Results: Thirteen cases had type 1 diabetes, and 6 cases had type 2 diabetes, including 2 new diagnoses. The most common precipitating factors were vomiting (55%) and insulin non-compliance (45%). Plasma glucose was <200 mg/dl in 50% of the patients. There was no maternal mortality, but there was one fetal death (5%). Only mean gestational age (21.8 ± 11.0 versus 33.7 ± 4.6 weeks, P=0.005) was significantly different between groups A (14 admissions) and B (6 admissions). Conclusion:The incidence of diabetic ketoacidosis was 0.5%, similar to the lowest incidence previously reported. Fetal mortality was 5%, lower than previously reported. The only factor associated with a favorable outcome was early gestational age at presentation. We recommend antenatal screening for diabetes, patient education, and compliance with insulin treatment as preventive measures against DKP.

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Diabetic ketoacidosis in pregnancy tends to occur at lower blood glucose levels: Case–control study and a case report of euglycemic diabetic ketoacidosis in pregnancy

Abstract: DKA in pregnant women with diabetes may occur more frequently, and at lower blood glucose levels than DKA in non-pregnant women with diabetes.

Cited by 91 publications

References 24 publications

Sodium-Glucose Cotransporter 2 Inhibition and Glycemic Control in Type 1 Diabetes: Results of an 8-Week Open-Label Proof-of-Concept Trial

Sodium-Glucose Cotransporter 2 Inhibition and Glycemic Control in Type 1 Diabetes: Results of an 8-Week Open-Label Proof-of-Concept Trial

Gebelik sırasında diabetik ketoasidoz: Olgu sunumu ve literatür derlemesi

Retrospective Analysis of Diabetic Ketoacidosis in Pregnant Women over a Period of 3 Years

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