Diabetic ketoacidosis and severe hypoglycemia in management of type 1 diabetes during 2003–2013

Urakami, Tatsuhiko; Habu, Masako; Suzuki, Junichi

doi:10.1111/ped.12521

Cited by 10 publications

(9 citation statements)

References 4 publications

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“…Many previous studies have focused on the risk factors for amputation in patients with DF (8,11,(15)(16)(17), and few studies have investigated the preoperative blood glucose management of patients who require surgical treatment for DF. The results of the present study revealed that most patients had poor blood glucose management before surgery, which is consistent with observations in previous reports (18)(19)(20). The most common blood glucose-related condition in our patients was hyperglycemia.…”

Section: Discussionsupporting

confidence: 93%

Incidence and risk factors for poor perioperative blood glucose management in patients with diabetic foot: a retrospective study

Chen¹,

Meifang²,

Hu³

et al. 2021

Ann Palliat Med

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Background: Diabetic foot (DF) is one of the most serious complications of diabetes mellitus (DM).In some cases of DF, life-saving amputation is necessary. This study set out to investigate the situation of preoperative blood glucose management in patients with DF.Methods: A retrospective study was performed in two centers between January 2015 and June 2018. Adult patients who received surgical treatment for DF, including amputation, debridement, and flap or skin graft, were included. Demographic and clinical data of the patients were collected. All patients were followed up for at least 3 years, until June 2021. The study outcomes included postoperative mortality, and the incidences of postoperative renal impairment, surgical infection, complete wound closure within 3 months, and reamputation. Univariable and multivariable logistic regression analyses were performed to determine the risk factors for adverse outcomes and poor blood glucose management. Kaplan-Meier curves were generated to compare survival between patients with different preoperative levels of blood glucose.Results: This study included 268 patients with DF, who were divided into four groups: normal (n=72), hyperglycemia (n=95), hypoglycemia (n=44), and mixed (n=57). Total mortality was much higher in the hyperglycemia, hypoglycemia, and mixed groups than in the normal group (P=0.030, 0.009, and 0.014, respectively). The incidences of surgical infection, complete wound closure within 3 months, and reamputation were significantly higher in the hyperglycemia, hypoglycemia, and mixed groups than in the normal group. Older age and a longer duration of DM were confirmed to be important risk factors for hyperglycemia, hypoglycemia, and mixed hyperglycemia and hypoglycemia. Having higher levels of glycosylated hemoglobin (HbA1c) and creatinine and a lower level of albumin was identified as a risk factor for hyperglycemia, hypoglycemia, or mixed hyperglycemia and hypoglycemia.Conclusions: This study emphasizes the importance of perioperative blood glucose management for patients with DF and provides a basis for blood glucose management of these patients in the future.

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Section: Discussionsupporting

confidence: 93%

Incidence and risk factors for poor perioperative blood glucose management in patients with diabetic foot: a retrospective study

Chen¹,

Meifang²,

Hu³

et al. 2021

Ann Palliat Med

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“…A population-based cohort of Western Australia demonstrated that the incidence of severe hypoglycemia was 17.3 per 100 patient-years in 2001 and 5.8 per 100 patient-years in 2006, and a 12% annual rate of decrease was observed during the study period ( 21 ). A similar decreased trend was also observed in children and adolescents in Germany and Australia ( 22 ) and in Japan ( 23 ). A recent Italian study conducted in 29 diabetes centers during 2011–2012 reported less incidence of 7.7 per 100 patient-years ( 24 ), whereas another Italian-center study showed higher incidence of 12.6 per 100 patient-years in 1990 and 16.5 per 100 patient-years in 2010, respectively ( Table 1 ).…”

Section: Incidencesupporting

confidence: 76%

Severe Hypoglycemia: Is It Still a Threat for Children and Adolescents With Type 1 Diabetes?

Urakami

2020

Front. Endocrinol.

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Severe hypoglycemia is defined as a condition with serious cognitive dysfunction, such as a convulsion and coma, requiring external help from other persons. This condition is still lethal and is reported to be the cause of death in 4-10% in children and adolescents with type 1 diabetes. The incidence of severe hypoglycemia in the pediatric population was previously reported as high as more than 50-100 patient-years; however, there was a decline in the frequency of severe hypoglycemia during the past decades, and relationship with glycemic control became weaker than previously reported. A lot of studies have shown the neurological sequelae with severe hypoglycemia as cognitive dysfunction and abnormalities in brain structure. This serious condition also provides negative psychosocial outcomes and undesirable compensatory behaviors. Various possible factors, such as younger age, recurrent hypoglycemia, nocturnal hypoglycemia, and impaired awareness of hypoglycemia, are possible risk factors for developing severe hypoglycemia. A low HbA 1c level is not a predictable value for severe hypoglycemia. Prevention of severe hypoglycemia remains one of the most critical issues in the management of pediatric patients with type 1 diabetes. Advanced technologies, such as continuous glucose monitoring (CGM), intermittently scanned CGM, and sensor-augmented pump therapy with low-glucose suspend system, potentially minimize the occurrence of severe hypoglycemia without worsening overall glycemic control. Hybrid closed-loop system must be the most promising tool for achieving optimal glycemic control with preventing the occurrence of severe hypoglycemia in pediatric patients with type 1 diabetes.

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“…166,172 A Japanese study showed that tube-and catheter-related problems, such as occlusion, kinking or accidental pull-out of catheters in CSII frequently can cause DKA especially in young children. 173 Thus, recommended practical tools and standardized guidelines for empowering patients to prevent, diagnose, and troubleshoot insulin infusion set failure and other problems that contribute to unexplained hyperglycemia need to employed to realize the full benefit of insulin pump therapy along the continuum of diabetes education. 174,175 Patients using insulin pumps, especially younger children, will benefit from being able to measure B-ketones via portable meters used in the home.…”

Section: Continuous Subcutaneous Insulin Infusionmentioning

confidence: 99%

“…Data on national levels have shown both an unchanged and an increased risk of DKA . A Japanese study showed that tube‐ and catheter‐related problems, such as occlusion, kinking or accidental pull‐out of catheters in CSII frequently can cause DKA especially in young children . Thus, recommended practical tools and standardized guidelines for empowering patients to prevent, diagnose, and troubleshoot insulin infusion set failure and other problems that contribute to unexplained hyperglycemia need to employed to realize the full benefit of insulin pump therapy along the continuum of diabetes education …”

Section: Administration Of Insulinmentioning

confidence: 99%

ISPAD Clinical Practice Consensus Guidelines 2018: Insulin treatment in children and adolescents with diabetes

et al. 2018

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Diabetic ketoacidosis and severe hypoglycemia in management of type 1 diabetes during 2003–2013

Cited by 10 publications

References 4 publications

Incidence and risk factors for poor perioperative blood glucose management in patients with diabetic foot: a retrospective study

Incidence and risk factors for poor perioperative blood glucose management in patients with diabetic foot: a retrospective study

Severe Hypoglycemia: Is It Still a Threat for Children and Adolescents With Type 1 Diabetes?

ISPAD Clinical Practice Consensus Guidelines 2018: Insulin treatment in children and adolescents with diabetes

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