Diabetic ketoacidosis

Dhatariya, Ketan; Glaser, Nicole; Codner, Ethel; Umpiérrez, Guillermo E.

doi:10.1038/s41572-020-0165-1

Cited by 233 publications

(360 citation statements)

References 270 publications

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“…Diabetic ketoacidosis is the most common hyperglycemic crisis, which also includes HHS and the combined syndrome of DKA and HHS, often referred to as hyperosmolar ketoacidosis [ 31 ]. Diabetic ketoacidosis occurs in the setting of relative or absolute insulin deficiency that tips the insulin:glucagon ratio in favor of glucagon; this leads to reduced glucose utilization and unchecked lipolysis, causing excessive formation of ketone bodies and finally metabolic acidosis [ 32 , 33 ]. Although DKA is more likely to occur in T1DM, it is estimated that the majority of the DKA cases worldwide occur in patients with T2DM due to its higher prevalence [ 33 ].…”

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

101

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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

101

View full text Add to dashboard Cite

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“…Diabetic ketoacidosis (DKA) is an acute, serious, and potentially life-threatening metabolic complication of type 1 diabetes ( 1 ). Although reported annual incidence of DKA varies widely, it is estimated to affect about 5–8% of adults with type 1 diabetes ( 2 – 4 ).…”

Section: Introductionmentioning

confidence: 99%

“…Although reported annual incidence of DKA varies widely, it is estimated to affect about 5–8% of adults with type 1 diabetes ( 2 – 4 ). From 2009 to 2014 in the U.S., DKA hospitalization rates increased an average of 6.3% each year ( 1 ). DKA incidence is highest in children and tends to decline with age ( 2 , 3 ).…”

Section: Introductionmentioning

confidence: 99%

“…Sodium–glucose cotransporter 2 (SGLT2) inhibitor use also has been identified as a risk factor for DKA in patients with diabetes ( 1 , 7 , 8 ). This risk is amplified in those who require insulin therapy, most commonly patients with type 1 diabetes ( 1 , 8 ). In May 2015, the U.S. Food and Drug Administration (FDA) issued a warning that SGLT2 inhibitor use may be associated with an increased risk of DKA, including euglycemic DKA ( 9 , 10 ).…”

Section: Introductionmentioning

confidence: 99%

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Diabetic Ketoacidosis and Related Events With Sotagliflozin Added to Insulin in Adults With Type 1 Diabetes: A Pooled Analysis of the inTandem 1 and 2 Studies

McGuire

Danne

Kushner³

et al. 2020

Diabetes Care

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OBJECTIVE To evaluate the incidence and risk factors for diabetic ketoacidosis (DKA) and related adverse events (AEs) in adults with type 1 diabetes treated with sotagliflozin adjunctive to insulin. RESEARCH DESIGN AND METHODS Data from two identically designed, 52-week, randomized studies were pooled and analyzed for DKA, changes in β-hydroxybutyrate (BHB), and percentage of patients with BHB >0.6 and >1.5 mmol/L. The patients were administered placebo, sotagliflozin 200 mg, or sotagliflozin 400 mg once daily. RESULTS A total of 191 ketosis-related AEs were reported, and 98 underwent adjudication. Of these, 37 events (36 patients) were adjudicated as DKA, with an exposure-adjusted incidence rate of 0.2, 3.1, and 4.2 events per 100 patient-years for placebo, sotagliflozin 200 mg, and sotagliflozin 400 mg, respectively. No patient died of a DKA event. From a baseline BHB of ∼0.13 mmol/L, sotagliflozin treatment led to a small median increase over 52 weeks (≤0.05 mmol/L at all time points). Of sotagliflozin-treated patients, approximately 47% and 7% had ≥1 BHB measurement >0.6 mmol/L and >1.5 mmol/L, respectively (vs. 20% and 2%, respectively, of placebo-treated patients). Subsequent to the implementation of a risk mitigation plan, annualized DKA incidence was lower versus preimplementation in both the sotagliflozin 200 and 400 mg groups. CONCLUSIONS In patients with type 1 diabetes, confirmed DKA incidence increased when sotagliflozin was added to insulin compared with insulin alone. A lower incidence of DKA was observed following the implementation of an enhanced risk mitigation plan, suggesting that this risk can be managed with patient education.

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“…The review focuses on T2D and does not include T1D. However, as a large proportion of people diagnosed with T1D have ketoacidosis, with incidence varying in different populations from 13% to 80% [22], recognising the main symptoms of T1D can help to get a diagnosis before ketoacidosis develops. Some of the most noticeable and common symptoms include excessive thirst, unusually high levels of urination, tiredness, loss of muscular bulk and unexplained weight loss.…”

Section: Introductionmentioning

confidence: 99%

Risk Prediction of the Diabetes Missing Million: Identifying Individuals at High Risk of Diabetes and Related Complications

et al. 2020

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Early diagnosis and effective management of type 2 diabetes (T2D) are crucial in reducing the risk of developing life-changing complications such as heart failure, stroke, kidney disease, blindness and amputation, which are also associated with significant costs for healthcare providers. However, as T2D symptoms often develop slowly it is not uncommon for people to live with T2D for years without being aware of their condition—commonly known as the undiagnosed missing million. By the time a diagnosis is received, many individuals will have already developed serious complications. While the existence of undiagnosed diabetes has long been recognised, wide-reaching awareness among the general public, clinicians and policymakers is lacking, and there is uncertainty in how best to identify high-risk individuals. In this article we have used consensus expert opinion alongside the available evidence, to provide support for the diabetes healthcare community regarding risk prediction of the missing million. Its purpose is to provide awareness of the risk factors for identifying individuals at high, moderate and low risk of T2D and T2D-related complications. The awareness of risk predictors, particularly in primary care, is important, so that appropriate steps can be taken to reduce the clinical and economic burden of T2D and its complications.

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Diabetic ketoacidosis

Cited by 233 publications

References 270 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

Diabetic Ketoacidosis and Related Events With Sotagliflozin Added to Insulin in Adults With Type 1 Diabetes: A Pooled Analysis of the inTandem 1 and 2 Studies

Risk Prediction of the Diabetes Missing Million: Identifying Individuals at High Risk of Diabetes and Related Complications

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