Hyperglycemic Crises in Patients With Diabetes Mellitus

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doi:10.2337/diacare.25.2007.s100

Cited by 16 publications

(5 citation statements)

References 31 publications

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“…The study subjects included in the analysis were admitted to King Abdullah University Hospital with the diagnosis of DKA between January 2015 and April 2018. DKA diagnosis is given according to the American Diabetes Association guidelines, 2 DKA was defined by pH less than 7.3, high glucose levels, positive ketones (serum or urine), and bicarbonate levels less than 18 mEq per L. Subjects determined eligible to be included in the analysis were 14 years or above, admitted to ICU with the diagnosis of DKA. Patients were determined to be type 1 or type 2 diabetes according to the history in medical records, age at time of diagnosis of diabetes, mode of presentation and medications used to treat diabetes from the outset.…”

Section: Methodsmentioning

confidence: 99%

“… 1 Diabetes ketoacidosis develops when insulin is completely or relatively deficient during the presence of excess counter-regulatory hormones. 2 Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of type 1 diabetes and has been classically associated with it. However, type 2 diabetes patients have increasingly been diagnosed with this complication.…”

Section: Introductionmentioning

confidence: 99%

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Diabetic Ketoacidosis in Northern Jordan: Seasonal Morbidity and Characteristics of Patients

Saadeh,

Hammouri,

Zahran

2023

DMSO

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Purpose This study aimed to characterize adult patients admitted with diabetic ketoacidosis (DKA) in northern Jordan. Methods The study examined medical records of patients diagnosed with DKA from January 2015 to April 2018. Variables analyzed included diabetes type, precipitating illness, admission month, hospital length of stay, and biochemical markers. Results Out of 232 admissions with DKA, 70% were diagnosed with type 2 diabetes, and 56% were females. 12% of admissions had a new diagnosis of diabetes, of which 51% had type 2 diabetes. Sepsis (48%), Non-adherence (26%), and diabetic foot infections (18%) were the most encountered precipitating factors for DKA in T1DM. As for T2DM, sepsis (52%), acute coronary syndrome (12%), and pancreatitis (8%) were the most precipitating factors for DKA. High urea levels, high creatinine levels, low phosphorous levels, low hemoglobin levels, and high platelet counts were associated with a longer hospital stay for type 1 diabetes. For type 2 diabetes, low pH on admission, old age, and high Hb A1c within 6 months of admission were factors associated with a prolonged hospital stay. The study found a significant peak of admissions for DKA in both type 1 and type 2 patients in the winter and spring months (Pearson P-value= 0.0013). Conclusion The results of the present study highlight the seasonal variation in the frequency of DKA hospitalizations. It also highlights sepsis as the most frequent precipitating factor of DKA in both type 1 and type 2 DM patients.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diabetic Ketoacidosis in Northern Jordan: Seasonal Morbidity and Characteristics of Patients

Saadeh,

Hammouri,

Zahran

2023

DMSO

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“…Other precipitating factors include major stresses that act by increasing insulin requirements and increasing secretion of the counter regulatory hormones including; myocardial infarction and cerebrovascular accident (CVA), alcohol abuse, pancreatitis, trauma, and drugs. In addition, new-onset T1DM or discontinuation of or inadequate insulin in established T1DM commonly leads to the development of DKA (Kitabchi et al, 2002). Drugs that affect carbohydrate metabolism, such as corticosteroids, thiazides, sympathomimetic agents (dobutamine and terbutaline) and cocaine may precipitate the development of HHS or DKA.…”

Section: Introductionmentioning

confidence: 99%

“…A study in United States reported the mortality rate of DKA in developed countries as (<1%), but associating DKA with detrimental neurocognitive outcomes and (>5%) in the elderly patients and in those with life threatening conditions (Duca, Wang, Rewers, & Rewers, 2017), (Kitabchi et al, 2002). With the increasing health care costs and a changing healthcare system, prevention of diabetic ketoacidosis remains very essential.…”

Section: Introductionmentioning

confidence: 99%

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Precipitating factors, presentation and outcomes of diabetic ketoacidosis among patients seen at moi teaching and referral hospital, eldoret kenya

Msagha,

Kamano,

Ayuo

2024

Preprint

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PRECIPITATING FACTORS, PRESENTATION AND OUTCOMES OF DIABETIC KETOACIDOSIS AMONG PATIENTS SEEN AT MOI TEACHING AND REFERRAL HOSPITAL, ELDORET KENYA. Clemence Msagha1, Jemima Kamano2, Paul Ayuo3 Background: Diabetes Ketoacidosis (DKA) is a major complication of Diabetes Mellitus (DM) with a likelihood of high mortality if not managed appropriately. It is diagnosed with a triad of hyperglycemia, ketonemia and metabolic acidosis. Objectives: To describe the precipitating factors, clinical presentation and outcomes of DKA among patients attending Moi Teaching and Referral Hospital (MTRH). Methods: This prospective study involved 120 consecutively recruited participants diagnosed with DKA. Participants were drawn from the Emergency department and Diabetes Outpatient clinic and followed up in the wards and intensive care unit (ICU) in MTRH for up to 10 days. Focused history and physical examination was done. Blood sugar was measured daily; blood ketones and blood gases were measured on days 1,2,3 and 5. Precipitating factors, presentation and outcomes were summarised as frequencies and their corresponding percentages and presented in tables and charts. Results: The median age of participants was 33 years (IQR 23, 44.5). Type 1 DM represented 63.3% and type 2 DM 34.2% of the patients. The most common precipitating factors for DKA were; new onset undiagnosed DM (37.5%), missed medication (36.7%) and infection (35.8%). The most common presentation was dehydration (97.5%) with 49.2% of the patients having severe DKA while 22.5% had mild DKA. Urine and blood ketones for diagnosis of DKA were present in 46.4% and 100% of patients respectively. The median length of hospital stay was 6 days (IQR 5,7) with infection being a significant determinant (aOR 2.63). The number of days taken for DKA to resolve ranged from 1 to 5 days with a median period of 3 days (IQR 2,3). DKA in-hospital mortality was 9.2% with new onset DM being a significant determinant (uOR 5.19). Conclusion: Some of the identified DKA precipitants in the study are preventable. The impact of DKA in MTRH is notable given the significant hospital stay and mortality. Recommendation: We recommend implementation research studies that would develop and test different strategies to address the precipitants to prevent DKA. For the hospital to undertake an audit of current DKA management process with the aim of improving outcomes in terms of hospital stay and mortality.

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Diabetic ketoacidosis in type 2 diabetes mellitus

Puttanna

Padinjakara

2014

Practical Diabetes

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Diabetic ketoacidosis is usually associated with type 1 diabetes; however, it is increasingly being recognised in type 2 diabetes. The three main mechanisms suggested are: insulinopaenia, elevation in counter‐regulatory hormones as a stress response, and increase in free fatty acids. This review aims to highlight the mechanism of diabetic ketoacidosis in type 2 diabetes, the difference compared to its occurrence in type 1 diabetes, the main triggers and its management. The most common mechanism is relative insulin deficiency (insulinopaenia) and usual triggers are non‐concordance or infection. Treatment is exactly the same as in type 1 diabetes with intravenous fluid resuscitation and insulin, though the duration of treatment may not be as long. These patients are able to stop insulin following resolution of ketoacidosis and can be managed on oral hypoglycaemic agents. It is important for clinicians to be aware of this condition due to the increasing burden of type 2 diabetes and to avoid unnecessary treatment with insulin in the long term.

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Hyperglycemic Crises in Patients With Diabetes Mellitus

Cited by 16 publications

References 31 publications

Diabetic Ketoacidosis in Northern Jordan: Seasonal Morbidity and Characteristics of Patients

Diabetic Ketoacidosis in Northern Jordan: Seasonal Morbidity and Characteristics of Patients

Precipitating factors, presentation and outcomes of diabetic ketoacidosis among patients seen at moi teaching and referral hospital, eldoret kenya

Diabetic ketoacidosis in type 2 diabetes mellitus

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