Event Rates and Risk Factors for the Development of Diabetic Ketoacidosis in Adult Patients With Type 1 Diabetes: Analysis From the DPV Registry Based on 46,966 Patients

Kalscheuer, Hannes; Seufert, Jochen; Lanzinger, Stefanie; Rosenbauer, Joachim; Karges, Wölfram; Bergis, Dominik; Mader, Julia K.; Zimny, Stefan; Schmid, Sebastian; Hummel, Michael; Kerner, W.; Holl, Reinhard W.

doi:10.2337/dc18-1160

Cited by 23 publications

(28 citation statements)

References 5 publications

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“…Additionally, DKA events were more common in patients with suboptimal versus optimal glycaemic control. This is generally in line with previous findings, such as those from the T1D Exchange Registry and the DPV Registry . Increased DKA incidence with poorer glycaemic control has also been reported in a recent systematic literature review that examined DKA among adults with T1D, and moreover in an international comparison of paediatric patients with T1D…”

Section: Discussionsupporting

confidence: 90%

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Differences between patients with type 1 diabetes with optimal and suboptimal glycaemic control: A real‐world study of more than 30 000 patients in a US electronic health record database

Pettus

Zhou

Shepherd

et al. 2019

Diabetes Obesity Metabolism

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Aims To use electronic health record data from real‐world clinical practice to assess demographics, clinical characteristics and disease burden of adults with type 1 diabetes (T1D) in the United States. Materials and methods Retrospective observational study of adults with T1D for ≥24 months at their first visit with a T1D diagnosis code (“index date”) between July 2014 and June 2016 in the Optum Humedica database. Demographic characteristics, acute complications (severe hypoglycaemia [SH], diabetic ketoacidosis [DKA]), microvascular complications, cardiovascular (CV) events and health care resource utilization during the 12 months before the index date (“baseline period”) were compared between patients with optimal versus suboptimal glycaemic control (glycated haemoglobin [HbA1c] <7.0% vs. ≥7.0% [53 mmol/mol]) at the closest measurement to the index date. Results Of 31 430 adults with T1D, 79.9% had suboptimal glycaemic control (mean HbA1c 8.8% [73 mmol/mol]). These patients were more likely to be younger, African American, uninsured or on Medicaid, obese, smokers, have uncontrolled hypertension and have depression. Despite worse glycaemic control and increased CV risk factors of uncontrolled hypertension, obesity and smoking, rates of coronary heart disease and stroke were not higher in these patients. Patients with suboptimal glycaemic control also experienced more diabetes complications (including SH, DKA and microvascular disease) and utilized more emergency care, with more emergency department visits and inpatient stays. Conclusion This real‐world study of >30 000 adults with T1D showed that individuals with suboptimal versus optimal glycaemic control differed significantly in terms of health care coverage, comorbidities, diabetes‐related complications, health care utilization and CV risk factors. However, suboptimal control was not associated with increased risk of CV outcomes.

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Section: Discussionsupporting

confidence: 90%

“…This is generally in line with previous findings, such as those from the T1D Exchange Registry 12,13 and the DPV Registry. 21 Increased DKA incidence with poorer glycaemic control has also been reported in a recent systematic literature review that examined DKA among adults…”

Section: Discussionmentioning

confidence: 64%

Differences between patients with type 1 diabetes with optimal and suboptimal glycaemic control: A real‐world study of more than 30 000 patients in a US electronic health record database

Pettus

Zhou

Shepherd

et al. 2019

Diabetes Obesity Metabolism

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“…In our systematic review, we found that the majority (63%) of the reported cases of DKA (or DKA/HHS) were male. Gender difference as a risk factor for DKA is controversial; some studies consider female sex as a risk factor [ 37 ], while others have shown no significant differences in males and females [ 38 ]. The preponderance of male cases among DKA patients could be due to the fact that COVID-19 tends to be more severe in males, resulting in more hospitalizations and deaths compared with females [ 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical profile and outcomes in COVID-19 patients with diabetic ketoacidosis: A systematic review of literature

Pal

Banerjee

Yadav

et al. 2020

Diabetes & Metabolic Syndrome: Clinical Research & Revi

102

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Background and aim To conduct a systematic literature review and analyze the demographic/biochemical parameters and clinical outcomes of COVID-19 patients with diabetic ketoacidosis (DKA) and combined DKA/HHS (hyperglycemic hyperosmolar syndrome). Methods PubMed, Scopus, Embase, and Google Scholar databases were systematically searched till August 3, 2020 to identify studies reporting COVID-19 patients with DKA and combined DKA/HHS. A total of 19 articles reporting 110 patients met the eligibility criteria. Results Of the 110 patients, 91 (83%) patients had isolated DKA while 19 (17%) had DKA/HHS. The majority of the patients were male (63%) and belonged to black ethnicity (36%). The median age at presentation ranged from 45.5 to 59.0 years. Most of the patients (77%) had pre-existing type 2 diabetes mellitus. Only 10% of the patients had newly diagnosed diabetes mellitus. The median blood glucose at presentation ranged from 486.0 to 568.5 mg/dl, being higher in patients with DKA/HHS compared to isolated DKA. The volume of fluid replaced in the first 24 h was higher in patients with DKA/HHS in contrast to patients with DKA alone. The in-hospital mortality rate was 45%, with higher mortality in the DKA/HHS group than in the isolated DKA group (67% vs. 29%). pH was lower in patients who had died compared to those who were discharged. Conclusion DKA in COVID-19 patients portends a poor prognosis with a mortality rate approaching 50%. Differentiating isolated DKA from combined DKA/HHS is essential as the latter represents nearly one-fifth of the DKA cases and tends to have higher mortality than DKA alone.

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“…Furthermore, the Guangdong Type 1 Diabetes Translational Study Group reported a much higher incidence across China (263 per 1,000 patient-years), which the investigators attributed to differences in national health-care systems, where people with T1DM have limited access to routine health care as well as infrequent self-monitoring of blood glucose 29 . However, in jurisdictions such as Taiwan, Germany and Italy, DKA hospitalization rates have decreased [30][31][32] . The reasons for this decrease are unknown but might be due to improvements in access to health care and/or increased recognition of the early signs of hyperglycaemia and DKA.…”

Section: Epidemiologymentioning

confidence: 99%

Diabetic ketoacidosis

Dhatariya

Glaser

Codner

et al. 2020

Nat Rev Dis Primers

246

201

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Diabetic ketoacidosis (DKA) is the most common acute hyperglycaemic emergency in people with diabetes mellitus. A diagnosis of DKA is confirmed when all of the three criteria are present-'D', either elevated blood glucose levels or a family history of diabetes mellitus; 'K', the presence of high urinary or blood ketoacids; and 'A', a high anion gap metabolic acidosis. Early diagnosis and management are paramount to improve patient outcomes. The mainstays of treatment include restoration of circulating volume, insulin therapy , electrolyte replacement and treatment of any underlying precipitating event. Without optimal treatment, DKA remains a condition with appreciable, although largely preventable, morbidity and mortality. In this Primer, we discuss the epidemiology , pathogenesis, risk factors and diagnosis of DKA and provide practical recommendations for the management of DKA in adults and children.

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Event Rates and Risk Factors for the Development of Diabetic Ketoacidosis in Adult Patients With Type 1 Diabetes: Analysis From the DPV Registry Based on 46,966 Patients

Cited by 23 publications

References 5 publications

Differences between patients with type 1 diabetes with optimal and suboptimal glycaemic control: A real‐world study of more than 30 000 patients in a US electronic health record database

Differences between patients with type 1 diabetes with optimal and suboptimal glycaemic control: A real‐world study of more than 30 000 patients in a US electronic health record database

Clinical profile and outcomes in COVID-19 patients with diabetic ketoacidosis: A systematic review of literature

Diabetic ketoacidosis

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