Long-term risk of stroke in type 2 diabetes patients with diabetic ketoacidosis: A population-based, propensity score-matched, longitudinal follow-up study

Chen, Y.-L.; Weng, Shih‐Feng; Yang, Chun-Ming; Wang, J.-J.; Tien, Kai‐Jen

doi:10.1016/j.diabet.2016.11.003

Cited by 13 publications

(13 citation statements)

References 27 publications

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“…14 22–25 On the other hand, those with type 2 diabetes who experience DKA may represent a more complex cohort, as studies have identified increased risk of complications, such as stroke, in this group in comparison with patients with type 2 diabetes who do not experience DKA. 26 Although our analyses did not find a significant difference in clinical parameters, multiple studies have indicated greater severity and mortality of DKA in patients with type 2 diabetes in comparison with those with type 1 diabetes. 14–16…”

Section: Discussioncontrasting

confidence: 73%

Clinical and biochemical profile of 786 sequential episodes of diabetic ketoacidosis in adults with type 1 and type 2 diabetes mellitus

Ooi

Nash

Rengarajan

et al. 2021

BMJ Open Diab Res Care

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IntroductionWe explored the clinical and biochemical differences in demographics, presentation and management of diabetic ketoacidosis (DKA) in adults with type 1 and type 2 diabetes.Research design and methodsThis observational study included all episodes of DKA from April 2014 to September 2020 in a UK tertiary care hospital. Data were collected on diabetes type, demographics, biochemical and clinical features at presentation, and DKA management.ResultsFrom 786 consecutive DKA, 583 (75.9%) type 1 diabetes and 185 (24.1%) type 2 diabetes episodes were included in the final analysis. Those with type 2 diabetes were older and had more ethnic minority representation than those with type 1 diabetes. Intercurrent illness (39.8%) and suboptimal compliance (26.8%) were the two most common precipitating causes of DKA in both cohorts. Severity of DKA as assessed by pH, glucose and lactate at presentation was similar in both groups. Total insulin requirements and total DKA duration were the same (type 1 diabetes 13.9 units (9.1–21.9); type 2 diabetes 13.9 units (7.7–21.1); p=0.4638). However, people with type 2 diabetes had significantly longer hospital stay (type 1 diabetes: 3.0 days (1.7–6.1); type 2 diabetes: 11.0 days (5.0–23.1); p<0.0001).ConclusionsIn this population, a quarter of DKA episodes occurred in people with type 2 diabetes. DKA in type 2 diabetes presents at an older age and with greater representation from ethnic minorities. However, severity of presentation and DKA duration are similar in both type 1 and type 2 diabetes, suggesting that the same clinical management protocol is equally effective. People with type 2 diabetes have longer hospital admission.

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Section: Discussioncontrasting

confidence: 73%

Clinical and biochemical profile of 786 sequential episodes of diabetic ketoacidosis in adults with type 1 and type 2 diabetes mellitus

Ooi

Nash

Rengarajan

et al. 2021

BMJ Open Diab Res Care

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“…Awareness is also increasing that complications of diabetic ketoacidosis may continue beyond the acute hospital admission. In one recent study of 3572 patients with type 2 diabetes and 7144 controls matched for age, sex, and baseline diabetes complications and comorbidities, patients with diabetic ketoacidosis were 1.55 times more like to experience a stroke within six months than were those without diabetic ketoacidosis 102. In another study examining long term outcomes in patients admitted to an intensive care unit with diabetic ketoacidosis, one in 10 patients died within one year of hospital discharge 103.…”

Section: Complications Related To Management Of Diabetic Ketoacidosismentioning

confidence: 99%

Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients

French

Donihi

Korytkowski

2019

BMJ

136

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Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome (HHS) are life threatening complications that occur in patients with diabetes. In addition to timely identification of the precipitating cause, the first step in acute management of these disorders includes aggressive administration of intravenous fluids with appropriate replacement of electrolytes (primarily potassium). In patients with diabetic ketoacidosis, this is always followed by administration of insulin, usually via an intravenous insulin infusion that is continued until resolution of ketonemia, but potentially via the subcutaneous route in mild cases. Careful monitoring by experienced physicians is needed during treatment for diabetic ketoacidosis and HHS. Common pitfalls in management include premature termination of intravenous insulin therapy and insufficient timing or dosing of subcutaneous insulin before discontinuation of intravenous insulin. This review covers recommendations for acute management of diabetic ketoacidosis and HHS, the complications associated with these disorders, and methods for preventing recurrence. It also discusses why many patients who present with these disorders are at high risk for hospital readmissions, early morbidity, and mortality well beyond the acute presentation.

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“…Specifically, the all-cause mortality rate was 22% for T1DM and 21% for T2DM [ 45 ]. Moreover, in T1DM, inadequate glycaemic control and female sex further increased the risk of stroke [ 46 , 47 ]. The adverse influence of female sex contrasts with the reduced risk in non-DM women [ 48 ].…”

Section: Epidemiology and Risk Factorsmentioning

confidence: 99%

Diabetes, Vascular Aging and Stroke: Old Dogs, New Tricks?

Penlioglou

Stoian

Παπάνας

2021

JCM

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Background: Stroke remains a leading cause of death and disability throughout the world. It is well established that Diabetes Mellitus (DM) is a risk factor for stroke, while other risk factors include dyslipidaemia and hypertension. Given that the global prevalence of diabetes steadily increases, the need for adequate glycaemic control and prevention of DM-related cardiovascular events remains a challenge for the medical community. Therefore, a re-examination of the latest data related to this issue is of particular importance. Objective: This review aims to summarise the latest data on the relationship between DM and stroke, including epidemiology, risk factors, pathogenesis, prevention and biomarkers. Methods: For this purpose, comprehensive research was performed on the platforms PubMed, Google Scholar and EMBASE with a combination of the following keywords: diabetes mellitus, stroke, macrovascular complications, diabetic stroke, cardiovascular disease. Conclusions: Much progress has been made in stroke in people with DM in terms of prevention and early diagnosis. In the field of prevention, the adaptation of the daily habits and the regulation of co-morbidity of individuals play a particularly important role. Simultaneously, the most significant revolution has been brought by the relatively new treatment options that offer protection to the cardiovascular system. Moreover, many prognostic and diagnostic biomarkers have been identified, paving the way for early and accurate diagnoses. However, to date, there are crucial points that remain controversial and need further clarification.

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Long-term risk of stroke in type 2 diabetes patients with diabetic ketoacidosis: A population-based, propensity score-matched, longitudinal follow-up study

Cited by 13 publications

References 27 publications

Clinical and biochemical profile of 786 sequential episodes of diabetic ketoacidosis in adults with type 1 and type 2 diabetes mellitus

Clinical and biochemical profile of 786 sequential episodes of diabetic ketoacidosis in adults with type 1 and type 2 diabetes mellitus

Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients

Diabetes, Vascular Aging and Stroke: Old Dogs, New Tricks?

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