Risk factors and prevention strategies for diabetic ketoacidosis in people with established type 1 diabetes

Ehrmann, Dominic; Kulzer, Bernhard; Roos, Timm; Haak, Thomas; Al-Khatib, Mohammed; Hermanns, Norbert

doi:10.1016/s2213-8587(20)30042-5

Cited by 81 publications

(80 citation statements)

References 114 publications

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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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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

View full text Add to dashboard Cite

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“…Besides, recurrent DKA is counting to be 20% as a result of contributing factors such as socioeconomic disadvantage, age (13–25 years), gender (female more than male) and psychiatric comorbidities like eating disorders and depression. [ 1 2 3 4 ]…”

Section: Introductionmentioning

confidence: 99%

Level of awareness of diabetic ketoacidosis among diabetes mellitus patients in Riyadh

Farran¹,

Elaiwah²,

Aldarsouny³

et al. 2020

J Family Med Prim Care

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Background: Diabetic ketoacidosis (DKA) is considered to be a serious acute life-menacing complication of diabetes type (1) and type (2). The study aims to assess the level of awareness regarding DKA among diabetic patients in the Riyadh population. Methodology: The study is an institution-based cross-sectional study with a sample size of 150 participants. The participants are chosen through systemic random sampling, who have type (1) or type (2) diabetes mellitus patients and are 18–35 years of age. The medical personnel were excluded from the study. A self-administered, precoded, and pretested questionnaire was developed especially for this study after consulting literature and epidemiologists containing data about the risk factor, management, and complication. Data were analyzed using (SPSS). A P value of less than 0.05 was considered significant. Results: 38.67% (58) participants have poor awareness regarding complications, 67.34% (101) have poor knowledge regarding management, and 6% (9) participants have a good knowledge, 38% (57) participants have poor knowledge regarding risk factors and 30% (45) of the participants have good awareness. The relation between having a first degree relative with diabetes and awareness regarding management is significant with a P value of 0.022; 73% (110) of the participants had no relatives with diabetes mellitus and 71% (79) had a poor level of awareness regarding the management of DKA. However, 55% (22) of respondents who had relatives with diabetes mellitus also had a poor level of awareness regarding treatment. Conclusion: The majority of the participants had a poor level of awareness. There is a relationship between having a first-degree relative with diabetic mellitus and the level of awareness regarding DKA.

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“…Current clinical guidance suggests that patients with low insulin needs, a history of diabetic ketoacidosis, non‐adherence to their insulin regimens or non‐compliance with treatment instructions, as well as patients facing socioeconomic disadvantages or psychiatric co‐morbidities, may have an increased risk for diabetic ketoacidosis. On the other hand, patients who may benefit more include those who are overweight or obese, on stable insulin therapy, adhere to their insulin regimens, can understand structured diabetes self‐management education and implement risk‐mitigation strategies 31,32 . Close monitoring for ketosis and interruption of treatment during stressful metabolic situations may decrease the risk of ketoacidosis.…”

Section: Discussionmentioning

confidence: 99%

Comparative efficacy and safety of glucose‐lowering drugs as adjunctive therapy for adults with type 1 diabetes: A systematic review and network meta‐analysis

Avgerinos

Manolopoulos

Michailidis

et al. 2021

Diabetes Obesity Metabolism

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Aim To assess the efficacy and safety of glucose‐lowering drugs used as an adjunct to insulin therapy in adults with type 1 diabetes. Methods We searched Medline, Embase and the Cochrane Central Register of Controlled Trials up to 24 January 2020 for randomized controlled trials. Our primary outcome was change in HbA1c. We additionally assessed eight efficacy and six safety secondary endpoints. We performed random effects frequentist network meta‐analysis to estimate mean differences (MDs) and odds ratios (ORs), alongside 95% confidence intervals (CIs). We assessed risk of bias and evaluated confidence in the evidence for the primary outcome. Results We included 58 trials comprising 13 216 participants. Overall, sodium‐glucose co‐transporter (SGLT) inhibitors, liraglutide, glibenclamide, acarbose and metformin reduced HbA1c compared with placebo (MDs ranging from −0.46% [95% CI −0.64% to −0.29%] for empagliflozin to −0.20% [−0.35% to −0.06%] for metformin). SGLT inhibitors, exenatide daily, liraglutide and metformin reduced body weight and total daily insulin dose, while liraglutide and SGLT inhibitors reduced blood pressure. Diabetic ketoacidosis and genital infections were more frequent with SGLT inhibitors, while exenatide, liraglutide, pramlintide and metformin increased the incidence of nausea. No drug increased the incidence of severe hypoglycaemia. Confidence in evidence was mainly moderate to very low. Conclusions Specific drugs may improve glycaemic control and reduce body weight, blood pressure and total daily insulin dose in patients with type 1 diabetes. However, low quality of evidence and an increased risk of diabetic ketoacidosis, genital infections or gastrointestinal adverse events should be taken into consideration by healthcare providers and patients. Future long‐term trials are needed to clarify their benefit‐to‐risk profile and elucidate their role in clinical practice.

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Risk factors and prevention strategies for diabetic ketoacidosis in people with established type 1 diabetes

Cited by 81 publications

References 114 publications

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

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

Level of awareness of diabetic ketoacidosis among diabetes mellitus patients in Riyadh

Comparative efficacy and safety of glucose‐lowering drugs as adjunctive therapy for adults with type 1 diabetes: A systematic review and network meta‐analysis

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