Comparison of Diabetic Ketoacidosis in Patients With Type-1 and Type-2 Diabetes Mellitus

Barski, Leonid; Nevzorov, R.; Jotkowitz, Alan; Rabaev, Elena; Zektser, Miri; Zeller, Lior; Shleyfer, Elena; Harman-Boehm, Ilana; Almog, Yaniv

doi:10.1097/maj.0b013e31827424ab

Cited by 74 publications

(53 citation statements)

References 23 publications

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“…The metabolic profile and biochemical parameters of DKA in these patients is similar to that found in T1D patients [10]. Unlike patients with T1D DKA, T2D patients with DKA are more likely to be older, obese, and do not show any autoimmune markers, they also appear to have less complications associated with management of DKA because of their age [11–14]. …”

Section: Ketone Metabolismmentioning

confidence: 61%

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Hyperketonemia and ketosis increase the risk of complications in type 1 diabetes

Marie

Jain

2016

Free Radical Biology and Medicine

132

109

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Diets that boost ketone production are increasingly used for treating several neurological disorders. Elevation in ketones in most cases is considered favorable, as they provide energy and are efficient in fueling the body’s energy needs. Despite all the benefits from ketones, the above normal elevation in the concentration of ketones in the circulation tend to illicit various pathological complications by activating injurious pathways leading to cellular damage. Recent literature demonstrates a plausible link between elevated levels of circulating ketones and oxidative stress, linking hyperketonemia to innumerable morbid conditions. Ketone bodies are produced by the oxidation of fatty acids in the liver as a source of alternative energy that generally occurs in glucose limiting conditions. Regulation of ketogenesis and ketolysis plays an important role in dictating ketone concentrations in the blood. Hyperketonemia is a condition with elevated blood levels of acetoacetate (AA), 3-β-hydroxybutyrate (BHB), and acetone. Several physiological and pathological triggers, such as fasting, ketogenic diet, and diabetes cause an accumulation and elevation of circulating ketones. Complications of the brain, kidney, liver, and microvasculature were found to be elevated in diabetic patients who had elevated ketones compared to those diabetics with normal ketone levels. This review summarizes the mechanisms by which hyperketonemia and ketoacidosis cause an increase in redox imbalance and thereby increasing the risk of morbidity and mortality in patients.

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Section: Ketone Metabolismmentioning

confidence: 61%

“…DKA has also been identified in T2D patients [14, 132]. Infections, new onset diabetes, and other unknown factors contribute to DKA in T2D [7, 11]. Elevated ketone levels in these patients are reported along with severe insulin resistance and worsening of hyperglycemia [63, 133].…”

Section: Pathological Ketosismentioning

confidence: 99%

Hyperketonemia and ketosis increase the risk of complications in type 1 diabetes

Marie

Jain

2016

Free Radical Biology and Medicine

132

109

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“…Barski et al did a comparative study in diabetic patients presented with DKA and reported that T2DM patients who were presented with DKA had significantly severe presentation and worse outcome than those who have Type 1 DM. 27 Many Indian studies still report mortality figures in the range of 20-30%. The possible reason for such a high mortality rates in Indian patients may be due to delayed presentation and poor socioeconomic conditions which influence the selection of better antibiotics for the treatment.…”

mentioning

confidence: 99%

A Prospective Study of Risk Factors, Clinical Profile and Outcome in Patients of Diabetic Ketoacidosis (DKA) in Type II Diabetes Patients

Sonwani¹,

Arya²,

Saxena³

2018

IJCMR

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“…23 The longer inward of patients with type 2 DM could be explained on the basis of older age and more frequent co-morbidities. 24 In the case of patients with DM onset, higher levels of plasma glucose and corrected Na + , and lower values of K + , could be explained by a more pronounced relative insulin deficiency state and glucotoxic effect during the DKA episode than in patients with known DM. This hypothesis could not be verified due to we have not routinely measured C-peptide in ED.…”

Section: Discussionmentioning

confidence: 95%

Clinical features, mortality, hospital admission, and length of stay of a cohort of adult patients with diabetic ketoacidosis attending the emergency room of a tertiary hospital in Spain

Guisado-Vasco¹,

Cano-Megías

Fuente

et al. 2015

Endocrinología y Nutrición (English Edition)

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Aim: To assess the clinical features, length of stay, incidence rate, mortality, and hospital admissions of patients with episodes of diabetic ketoacidosis (DKA). Patients: It was conducted retrospective, cross-sectional study of 164 consecutive admissions of adult patients (2008---August 2012), with type 1 or type 2 diabetes already known or new onset. Results: Mortality rate was 1.2%. The DKA episodes were mild (18.9%), moderate (31.7%), or severe (49.4%). The cumulative incidence was 2.66 cases/1000 patients with diabetes (DM) in 4.5 years. The most common causes triggering DKA were infection (33.2%) and dietary transgression and/or insulin dose omission (30.7%). A total of 12.8% of patients had new onset DM, 56.7% type 1, and 26.8% type 2 DM. Patients with type 2 DM were older and had at admission higher creatinine, BUN, osmolality, sodium, and anion gap levels. Patients with new-onset of DM had higher levels of glucose and sodium, but lower potassium levels. No differences were found in pH or bicarbonate. Admission to the intensive care unit (ICU) was required in >50% of cases (p < 0.001), and 86.6% of patients were finally admitted to a medical ward (p = 0.005). The length of stay at the ICU (p < 0.001) and hospital (p = 0.013) was significantly different depending on DKA severity. Conclusions: Most DKA episodes require hospital admission, but mortality is <2%, and length of stay at the ER and medical ward depends on type of DM and initial severity of the episode. P. Guisado-Vasco et al. PALABRAS CLAVECetoacidosis diabética; Diabetes mellitus; Mortalidad; Hospitalización; Duración de la estancia; Urgencias Características clínicas, mortalidad, hospitalización y duración de la estancia de pacientes adultos con cetoacidosis diabética admitidos en un servicio de urgencias de un hospital terciario en España ResumenObjetivo: Se investigaron las características clínicas, la duración, la tasa de incidencia, la mortalidad y los ingresos de episodios de cetoacidosis diabética (CAD). Pacientes: Se realizó un estudio retrospectivo, transversal, con 164 admisiones consecutivas de adultos (2008---agosto 2012), con diabetes (DM) tipo 1 y 2 ya conocida o debut diabético. Resultados: La tasa de mortalidad fue del 1,2%. Los episodios de CAD fueron leves (18,9%), moderados (31,7%) y graves (49,4%). La incidencia acumulada fue de 2,66 casos/1.000 pacientes con DM en 4,5 años. Las causas desencadenantes más frecuentes fueron las infecciones (33,2%) y la transgresión dietética y/u omisión de la dosis de insulina (30,7%). El 12,8% tuvieron un debut diabético, 56,7% eran DM tipo 1 y el 26,8% tipo 2. Los casos con DM tipo 2 tenían mayor edad y presentaban al ingreso mayores niveles de creatinina, BUN, osmolaridad, sodio y anion GAP. El debut diabético presentaba niveles más elevados de glucosa y sodio, pero valores más bajos de potasio. No se encontró ninguna diferencia en el pH o bicarbonato. La admisión en la unidad de cuidados intensivos (UCI) se requirió en más del 50% de los casos (p < 0,001) y un 86,6% fue finalmente ingresa...

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Comparison of Diabetic Ketoacidosis in Patients With Type-1 and Type-2 Diabetes Mellitus

Cited by 74 publications

References 23 publications

Hyperketonemia and ketosis increase the risk of complications in type 1 diabetes

Hyperketonemia and ketosis increase the risk of complications in type 1 diabetes

A Prospective Study of Risk Factors, Clinical Profile and Outcome in Patients of Diabetic Ketoacidosis (DKA) in Type II Diabetes Patients

Clinical features, mortality, hospital admission, and length of stay of a cohort of adult patients with diabetic ketoacidosis attending the emergency room of a tertiary hospital in Spain

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