Clinical characteristics and outcomes of care in adult patients with diabetic ketoacidosis: A retrospective study from a tertiary diabetes center in Thailand

Abstract

Background Diabetic ketoacidosis (DKA) is a metabolic catastrophe which could occur in any type of diabetes. Even when fundamental key points of DKA treatment had been followed, some differences exist in treatment protocols in each physician, highlighting the need to assess adherence to DKA guideline. Aim This study aimed to examine trend of hospitalized DKA patients and outcomes of treatment over a decade at Theptarin Hospital, a multi-discipline based diabetes center in Thailand . Method A retrospective study of DKA episodes admitted over a 14-year period (2005–2018) was done. Clinical characteristics, laboratory data, type of diabetes, severity of DKA were collected and analyzed. Results A total of 94 DKA episodes occurred in 81 diabetic patients (females 61.5%, mean age 47.4 ± 20.4 years, T1DM 41.5%, T2DM 50.0%, Ketosis-prone diabetes 8.5%, baseline A1C 10.8 ± 3.0%). While infection was the common precipitating factor in T2DM, omission of insulin was the usual precipitating factor in T1DM. During ongoing management, 26.6% of patients developed hypokalemia and supplementation was not prescribed as per protocol in this group of patients. Almost 13% of patients experienced hypoglycemia in the first 24 h. Median time to resolution of DKA was 8.5 h. Four T2DM patients expired from the precipitating cause of DKA which accounted for mortality rate at 4.3% in our study. Conclusions Inadequate metabolic monitoring and iatrogenic hypoglycemia remain areas of concern for DKA management. Occurrence of hypokalemia was related to poor adherence to protocol guidance on potassium supplementation. A strengthened educational program for nursing and medical staffs should be emphasized.

Profile of Diabetic Ketoacidosis Patients at Regional Public Hospital Dr. Soetomo in 2017

“…The DKA patients in this study consisted of 7 patients of type 1 DM (11.11%) and 56 patients with type 2 DM (88.89%). This result is in accordance with George, Mishra, & Iyadurai (2018), Thewjitcharoen et al, (2019), and Usman, Syed Sulaiman, Khan, & Adnan (2015). DKA is always associated with type 1 DM but, lately, the prevalence of DKA in patients with type 2 DM has been increasing.…”

“…Two thirds of the patients (66.67%) had a length of stay from 0-7 days (mean 6.60 ± 5.25 days). This is consistent with Almalki, Buhary, Khan, Almaghamsi, &Alshahrani, 2016 andThewjitcharoen et al (2019). Some aspects that could affect the length of stay are the severity of the DKA, the severity of the metabolic acidosis, and any underlying comorbidities.…”

“…DKA patients are mostly aged from 50-59 years (38.10%), with the mean age being 49.51 ± 13.88 years. This result is in accordance with George, Mishra, & Iyadurai (2018), Thewjitcharoen et al, (2019), and Usman, Syed Sulaiman, Khan, & Adnan (2015). Factors that make the elderly more susceptible to DKA are decreased pancreatic beta cells' regenerative capabilities and insulin secretion with a sedentary lifestyle (Lee & Halter, 2017).…”

“…This condition is called euglycemic diabetic ketoacidosis. A study conducted in Thailand reported that 6.4% of DKA cases also had euglycemia (Thewjitcharoen et al, 2019). The mechanism underlying this is a decrease in hepatic glucose production (in a fasting state) or an increase in glucose excretion in urine induced by excessive levels of contraregulator hormones-the first mechanism is more common.…”

“…To prevent fatal outcomes, it is of paramount importance that a proper diagnosis is made and prompt treatment is initiated. The education program for medical personnel must be strengthened, and guidelines need to be updated regularly to improve the quality of patient care (Thewjitcharoen et al, 2019).…”