Features and long‐term outcomes of patients hospitalized for diabetic ketoacidosis

Abstract

Background Diabetic ketoacidosis (DKA) is an acute metabolic complication characterized by hyperglycaemia, ketones in blood or urine, and acidosis. Objective The aim of this study was to characterize features of patients hospitalized for DKA, to identify triggers for DKA and to evaluate the long‐term effects of DKA on glycaemic control, complications of diabetes, re‐hospitalizations, and mortality. Methods Historical prospectively collected data of patients hospitalized to medical wards for DKA between 2011 and 2017. Data regarding comorbidities, mortality, triggers, and re‐hospitalizations for DKA were also collected. Results The cohort consisted of 160 patients (mean age 38 ± 18 years, 43% male). One fifth of the patients (34 patients, 21%) were newly diagnosed with diabetes, and DKA was their first presentation of the disease. Among the 126 patients with pre‐existing diabetes, the common identified triggers for DKA were poor compliance to treatment (22%) and infectious diseases (18%). During over 7 years of follow‐up, mortality rate was 9% (15 patients), and re‐hospitalization for DKA rate was 31% (50 patients). Risk factors for re‐hospitalization for DKA included young age (OR = 1.02, 95% CI, 1.00–1.04), pre‐existing diabetes compared to DKA as the first presentation (OR = 5.4, 95% CI, 1.7–18), and poorer glycaemic control before initial hospitalization (10.5 ± 2.5% vs. 9.4 ± 2.2%; OR = 0.8, 95% CI [0.68‐0.96]) and after discharge (10.3 ± 2.4% vs. 9.0 ± 1.9%; OR = 0.73, 95% CI [0.61–0.87]). Laboratory tests during the initial hospitalization, smoking, alcohol, or comorbidities did not increase the risk for re‐hospitalization for DKA. Conclusions The risk for readmission for DKA is higher for young patients with long duration of diabetes, poor compliance of insulin treatment and poorly controlled diabetes.

Hyperlactatemia associated with diabetic ketoacidosis in pediatric intensive care unit

“…The clinical manifestations of DKA include dehydration, Kussmaul respiration, nausea, vomiting, abdominal pain, loss of consciousness, leukocytosis, and increased serum amylase [4].A study showed that mortality rate was 9 %, and readmission for DKA rate was 31 % during over 7 years of follow-up of patients with DKA [15]. DKA mainly occurs in patients with type 1 diabetes mellitus, but it can also occur in patients with type 2 diabetes mellitus [16].…”

Hyperglycaemic crises in adults with diabetes: a consensus report

“…Risk factors Between 6% and 21% of adults present with DKA as their initial diagnosis of type 1 diabetes [21,24,44]. In adults with a known history of diabetes, the most common precipitating factors for DKA include infections, intercurrent illnesses, psychological stress, and omission or insufficient use of insulin therapy, as described in Table 1 [24,27,28,30,38,[44][45][46][47][48][49][50][51][52]. Worldwide, infection is the most common precipitating factor for DKA, occurring in 14-58% of cases [3,24].…”

One third of cases of new‐onset diabetic ketosis in adults are associated with ketosis‐prone type 2 diabetes—A systematic review and meta‐analysis

“…However, patients with type 2 diabetes were excluded from this study. 12 The major diagnostic challenge in adult patients with new-onset diabetes presenting with ketoacidosis or ketosis is to elucidate whether it is caused by type 1 or ketosis-prone type 2 diabetes. It is essential to increase awareness and facilitate an understanding of ketosis-prone type 2 diabetes among clinicians, as it is still a new entity with an incompletely characterised prevalence and clinical course.…”

“…A recent publication showed that one fifth of adult patients admitted for DKA were newly diagnosed with diabetes. However, patients with type 2 diabetes were excluded from this study 12 . The major diagnostic challenge in adult patients with new‐onset diabetes presenting with ketoacidosis or ketosis is to elucidate whether it is caused by type 1 or ketosis‐prone type 2 diabetes.…”