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

Abstract

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.

Clinical characteristics and outcomes of care in patients hospitalized with diabetic ketoacidosis

“…This likely contributed to the more extended hospital stay, increased admission to the intensive care unit, and a 7-fold increase in mortality in patients with T2DM, consistent with previous studies (33)(34)(35)(36)(37). Thus, Ooi and colleagues found a similar clinical presentation and disease severity between patients with T1DM and T2DM hospitalized with DKA but with a more extended hospital stay in patients with T2DM (33). Several studies have found a higher inpatient mortality in patients with DKA and T2DM than T1DM (14,35,36), which may be attributed to older age and more comorbidities in patients with T2DM (33).…”

“…Non-adherence to diabetes therapy and infection were the most common precipitating causes for hospitalization for DKA in our cohort. Non-adherence to insulin was the most typical cause for DKA in patients with T1DM, while infection was the leading cause in patients with T2DM, which is consistent with other studies (11,(33)(34)(35)(36)(37)(38)(39). Since recurrent DKA is associated with increased morbidity and mortality, identifying precipitating factors is key to the long-term management of patients with DKA.…”

“…Although, as expected, patients with T2DM were older, had more comorbid medical conditions, and had higher rates of infection than patients with T1DM. This likely contributed to the more extended hospital stay, increased admission to the intensive care unit, and a 7-fold increase in mortality in patients with T2DM, consistent with previous studies (33)(34)(35)(36)(37). Thus, Ooi and colleagues found a similar clinical presentation and disease severity between patients with T1DM and T2DM hospitalized with DKA but with a more extended hospital stay in patients with T2DM (33).…”

“…Thus, Ooi and colleagues found a similar clinical presentation and disease severity between patients with T1DM and T2DM hospitalized with DKA but with a more extended hospital stay in patients with T2DM (33). Several studies have found a higher inpatient mortality in patients with DKA and T2DM than T1DM (14,35,36), which may be attributed to older age and more comorbidities in patients with T2DM (33).…”

The Impact of Cirrhosis on Outcomes of Patients Admitted With Diabetic Ketoacidosis: A Nationwide Study

“…Diabetic ketoacidosis (DKA) is the most common acute hyperglycemic emergency in people with diabetes mellitus (DM) [ 1 ]. This potentially life-threatening complication can occur in both type 1 and type 2 DM, and it can be associated with significant morbidity and increased length of hospital stay [ 2 , 3 ]. Mortality rates in DKA patients have fallen significantly in the past 20 years to <1% [ 3 , 4 ].…”