Mortality and outcome of patients with brittle diabetes and recurrent ketoacidosis

Kent, L.A.; Williams, Gareth; Gill, GV

doi:10.1016/s0140-6736(94)92340-x

Cited by 71 publications

(38 citation statements)

References 26 publications

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“…Due to the lack of endogenous insulin secretion from the onset, strict glycaemic control is usually difficult and blood glucose levels tend to be erratic, as in brittle diabetes, even with intensified insulin treatments. Brittle diabetes itself is one of the risk factors for microangiopathy [7]. These phenomena prompted us to hypothesise that patients with fulminant type 1 diabetes may have higher risks of developing microangiopathic complications.…”

Section: Introductionmentioning

confidence: 99%

Fulminant type 1 diabetes as a high risk group for diabetic microangiopathy—a nationwide 5-year-study in Japan

et al. 2007

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Aims/hypothesis The aim of the present study was to assess the development of microangiopathy in patients with fulminant type 1 diabetes, a novel subtype of type 1B diabetes. Materials and methods In a nationwide survey, we followed 41 patients with fulminant type 1 diabetes and 76 age-and sex-matched patients with type 1A diabetes for 5 years. The following data were recorded every 12 months after the onset of diabetes: seven-point blood glucose concentrations, HbA 1c level, urinary albumin excretion, serum C-peptide level, blood pressure, daily dosages of insulin, frequency of severe hypoglycaemic episodes, and neurological and fundoscopic examination. ResultsThe 5-year cumulative incidence of microangiopathy was 24.4% in fulminant type 1 diabetes and 2.6% in type 1A diabetes. In longitudinal studies using the KaplanMeier method, the cumulative incidence of each form of microangiopathy was significantly higher in fulminant type 1 diabetes than in type 1A diabetes; retinopathy was 9.8% vs 0% (p=0.014), nephropathy 12.2% vs 2.6% (p=0.015) and neuropathy 12.2% vs 1.3% (p=0.010), respectively. Mean HbA 1c levels were similar in the fulminant and type 1A diabetes groups during the follow-up periods. However, the mean M-value, mean insulin dosages and the frequency of severe hypoglycaemic episodes were significantly higher, and the mean postprandial C-peptide level was significantly lower in the fulminant type 1 diabetes group.

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Section: Introductionmentioning

confidence: 99%

Fulminant type 1 diabetes as a high risk group for diabetic microangiopathy—a nationwide 5-year-study in Japan

et al. 2007

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“…It is typically associated with the psychosocial stresses and these patients have increased risk of diabetic complications and mortality 3 . Although there are various proposed biochemical abnormalities including defective insulin absorption, accelerated degradation at insulin injection site and inappropriate secretion of various counter regulatory hormones, most of the instability is usually self-induced by the patient.…”

Section: Discussionmentioning

confidence: 99%

Recurrent hypoglycaemia in a patient with brittle diabetes

et al. 2001

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A 27-year-old woman with 15 years history of 'brittle' type 1 diabetes presented with recent history of secondary amenorrhoea and recurrent episodes of hypoglycaemia. In the past, there had been clear evidence of non-concordance with treatment. She had had a total thyroidectomy at the age of 22 for thyrotoxicosis. Investigations confirmed Addison's disease and polyglandular autoimmune syndrome (PGA) type two.This case demonstrates the complex interaction between medical and psychological causes for erratic glycaemic control in diabetes, even within the same patient.

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“…This de®nition was adapted from other studies on brittle diabetes 3,6 . The questionnaire, which was kept very simple to encourage cooperation, requested age and sex of any elderly brittle patients in the clinic, their type of glycaemic instability (recurrent ketoacidosis, recurrent hypoglycaemia, or mixed brittleness), and possible causes for instability.…”

Section: Methodsmentioning

confidence: 99%

“…Such patients tend to defy all attempts at orthodox glycaemic control and the condition disrupts the lives of themselves, their relatives and their healthcare teams 4,5 . Recurrent and long hospital admissions are the rule 1,5,6 . Most patients with brittle diabetes are in the second or third decade of life 7,8 , and they are typically admitted with ketoacidosis (DKA) rather than hypoglycaemia or mixed patterns of instability 7± 9 .…”

Section: Introductionmentioning

confidence: 99%

Brittle diabetes in the elderly

Benbow¹,

Gallagher²

2004

Unstable and Brittle Diabetes

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SUMMARYSeverely unstable, or brittle, diabetes can be disruptive to patients, carers and diabetes care teams. The peak age-group for brittle diabetes is 15±30, but there are reports of its occurrence in much older patients. To explore the characteristics and cause of brittle instability perceived by diabetologists in elderly patients we circulated a questionnaire to all UK hospital diabetic clinics for adults. 130 (56%) of 231 replied. Reports were obtained on 55 patients ful®lling our criteria for`elderly brittle diabetes'Ðnamely, age 560 years, on insulin treatment, and experiencing life-disrupting glycaemic instability of any kind associated with frequent or long admissions to hospital. Further information was obtained by a research nurse who visited the relevant clinics.The mean age of patients was 74 years (range 60±89) and 71% were female. The brittleness was classed as mixed glycaemic instability in 22 (44%), recurrent ketoacidosis in 16 (29%) and recurrent hypoglycaemia in 15 (27%). In 2 cases there was insuf®cient information for classi®cation. The diabetes care team judged the brittleness to have multiple origins in two-thirds of the cases: problems with memory or behaviour were rare, and in only 4 cases was deliberate manipulation of therapy considered a possibility. 84% of the patients were living independently.

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Mortality and outcome of patients with brittle diabetes and recurrent ketoacidosis

Cited by 71 publications

References 26 publications

Fulminant type 1 diabetes as a high risk group for diabetic microangiopathy—a nationwide 5-year-study in Japan

Fulminant type 1 diabetes as a high risk group for diabetic microangiopathy—a nationwide 5-year-study in Japan

Recurrent hypoglycaemia in a patient with brittle diabetes

Brittle diabetes in the elderly

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