Morbidity and Mortality of Diabetic Ketoacidosis With and Without Insulin Pump Care

Abstract

Diabetic ketoacidosis (DKA) is one of the most common, costly, and dangerous acute complications in people with type 1 diabetes (T1D). Although DKA has been reported to occur with less frequency than severe hypoglycemia, it is associated with a higher mortality rate and is the leading cause of diabetes-related deaths in children and adolescents. The most common risk factor for DKA is lack of adherence to insulin treatment. Other factors include underinsurance, psychiatric disorders, occlusion of insulin pump infusion sets, and illness. It has been suggested that use of continuous subcutaneous insulin infusion therapy may increase the risk for DKA, although clinical trials have not supported this claim. Expert care within a T1D specialty clinic may help reduce the risk of DKA mortality. Further advances are needed in developing new technologies and methods to improve glycemic control in intensively treated patients without increasing the risk of acute complications. The purpose of this review is to discuss DKA morbidity and mortality in youth with T1D, particularly in relation to insulin pump use.

Mortality and acute complications in children and young adults diagnosed with Type 1 diabetes in Yorkshire, UK: a cohort study

“…Despite improvements in all-cause mortality, no improvements were found in deaths from acute complications. This is concerning, particularly as the present study and other studies have shown that such deaths occur at younger ages [7,10,22,[24][25][26]. Additionally, Cox regression showed that only sex was significantly associated with mortality risk from acute complications, with a notable increased risk in boys/men.…”

Clinical review: insulin pump-associated adverse events in adults and children

“…However, reassuringly, appropriate resumption of flow with modern insulin analogues halts this rise and can reverse it given enough time [37]. These concerns have been further allayed by a meta-analysis of 52 studies, suggesting that the incidence of DKA is not increased in those using modern CSII [39]. In addition, recent long-term outcome data report the rate of hospitalisation for DKA in CSII, at half that of those on MDI (1160 patient-years of follow-up, 2.3 hospitalisations per 100 patient-years for CSII compared with 4.7 for MDI) [40].…”

De la bomba de insulina y el monitoreo continuo de glucosa al páncreas artificial

“…Con más de 60 minutos de interrupción en la entrega del análogo, ocurre elevación significativa de la glicemia que, de no corregirse, da lugar a formación de cuerpos cetó-nicos, pudiendo llegar a CAD en pocas horas [33][34] . Recientemente se ha visto que la incidencia de CAD no es mayor que con MDI al utilizar ICSI modernos 35 . Esta complicación es prevenible con una adecuada selección y educación del paciente en el manejo del dispositivo y set de infusión.…”