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Observational Study
. 2021 Dec;9(2):e002451.
doi: 10.1136/bmjdrc-2021-002451.

Clinical and biochemical profile of 786 sequential episodes of diabetic ketoacidosis in adults with type 1 and type 2 diabetes mellitus

Emma Ooi  1 , Katrina Nash  2 , Lakshmi Rengarajan  3 , Eka Melson  3   4 , Lucretia Thomas  2 , Agnes Johnson  2 , Dengyi Zhou  2 , Lucy Wallett  3 , Sandip Ghosh  3 , Parth Narendran  3   5 , Punith Kempegowda  6   4
Affiliations
Observational Study

Clinical and biochemical profile of 786 sequential episodes of diabetic ketoacidosis in adults with type 1 and type 2 diabetes mellitus

Emma Ooi et al. BMJ Open Diabetes Res Care. 2021 Dec.

Abstract

Introduction: We explored the clinical and biochemical differences in demographics, presentation and management of diabetic ketoacidosis (DKA) in adults with type 1 and type 2 diabetes.

Research design and methods: This observational study included all episodes of DKA from April 2014 to September 2020 in a UK tertiary care hospital. Data were collected on diabetes type, demographics, biochemical and clinical features at presentation, and DKA management.

Results: From 786 consecutive DKA, 583 (75.9%) type 1 diabetes and 185 (24.1%) type 2 diabetes episodes were included in the final analysis. Those with type 2 diabetes were older and had more ethnic minority representation than those with type 1 diabetes. Intercurrent illness (39.8%) and suboptimal compliance (26.8%) were the two most common precipitating causes of DKA in both cohorts. Severity of DKA as assessed by pH, glucose and lactate at presentation was similar in both groups. Total insulin requirements and total DKA duration were the same (type 1 diabetes 13.9 units (9.1-21.9); type 2 diabetes 13.9 units (7.7-21.1); p=0.4638). However, people with type 2 diabetes had significantly longer hospital stay (type 1 diabetes: 3.0 days (1.7-6.1); type 2 diabetes: 11.0 days (5.0-23.1); p<0.0001).

Conclusions: In this population, a quarter of DKA episodes occurred in people with type 2 diabetes. DKA in type 2 diabetes presents at an older age and with greater representation from ethnic minorities. However, severity of presentation and DKA duration are similar in both type 1 and type 2 diabetes, suggesting that the same clinical management protocol is equally effective. People with type 2 diabetes have longer hospital admission.

Keywords: diabetes mellitus type 1; diabetes mellitus type 2; diabetic ketoacidosis; endocrine system diseases.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Guidelines for DKA treatment at our center. BP, blood pressure; DKA, diabetic ketoacidosis; GCS, Glasgow Coma Scale; HbA1c, glycated haemoglobin; SGLT2, sodium-glucose cotransporter-2; ITU, intensive treatment unit.
Figure 2
Figure 2
Proportion of various precipitating causes of DKA from 2014 to 2020: (A) overall, (B) people with type 1 diabetes, (C) people with type 2 diabetes and (D) year-wise. DKA, diabetic ketoacidosis; SGLT2, sodium-glucose cotransporter-2 inhibitors; T1DM, type 1 diabetes mellitus.
Figure 3
Figure 3
Differences in diabetic ketoacidosis (DKA) duration in hours (A) and length of hospitalization in days (B) based on the year of the episode compared with 2014 (*p<0.05).
See this image and copyright information in PMC

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References

    1. The management of diabetic ketoacidosis in adults. Available: http://www.diabetologists-abcd.org.uk/JBDS/JBDS.htm [Accessed 2 Feb 2021].
    1. Umpierrez GE, Kitabchi AE. Diabetic ketoacidosis: risk factors and management strategies. Treat Endocrinol 2003;2:95–108. 10.2165/00024677-200302020-00003 - DOI - PubMed
    1. Faich GA, Fishbein HA, Ellis SE. The epidemiology of diabetic acidosis: a population-based study. Am J Epidemiol 1983;117:551–8. 10.1093/oxfordjournals.aje.a113577 - DOI - PubMed
    1. Johnson DD, Palumbo PJ, Chu CP. Diabetic ketoacidosis in a community-based population. Mayo Clin Proc 1980;55:83–8. - PubMed
    1. Lin S-F, Lin J-D, Huang Y-Y. Diabetic ketoacidosis: comparisons of patient characteristics. Clinical Presentations and Outcomes Today and 20 Years Ago 2005. - PubMed

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