Clinical profile of patients with diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome in Japan: a multicenter retrospective cohort study

Kyosuke Takahashi^#¹, Norimichi Uenishi^#², Masamitsu Sanui³, Shigehiko Uchino³, Naoki Yonezawa⁴, Tetsuhiro Takei⁴, Norihiro Nishioka^{5

6}, Hirotada Kobayashi^{7

8

9}, Shunichi Otaka^{10

11}, Kotaro Yamamoto¹², Hideto Yasuda^{12

13}, Shintaro Kosaka¹⁴, Hidehiko Tokunaga¹⁴, Naoki Fujiwara^{14

15}, Takashiro Kondo¹⁶, Tomoki Ishida^{17

18}, Takayuki Komatsu^{19

20}, Koji Endo^{21

22}, Taiki Moriyama^{23

24}, Takayoshi Oyasu²⁵, Mineji Hayakawa²⁵, Atsumi Hoshino^{26

27}, Tasuku Matsuyama²⁸, Yuki Miyamoto²⁸, Akihiro Yanagisawa^{29

30}, Tadamasa Wakabayashi^{31

32}, Takeshi Ueda³³, Tetsuya Komuro^{34

35}, Toshiro Sugimoto^{36

37}, Alan Kawarai Lefor³⁸

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-Ku, Saitama City, Saitama Prefecture, 330-0834, Japan. ktakahashi@cf.em-net.ne.jp.
² Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
³ Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-Ku, Saitama City, Saitama Prefecture, 330-0834, Japan.
⁴ Department of Emergency and Critical Care Medicine, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan.
⁵ Department of Preventive Services, Kyoto University Graduate School of Medicine, Sakyo, Kyoto, Japan.
⁶ Division of Nephrology, Department of Internal Medicine, Okinawa Prefectural Chubu Hospital, Uruma, Okinawa, Japan.
⁷ Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
⁸ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
⁹ Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan.
¹⁰ Department of Emergency Medicine, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan.
¹¹ Department of Emergency Medicine, Kumamoto Red Cross Hospital, Higashi, Kumamoto, Japan.
¹² Department of Emergency Medicine, Musashino Red Cross Hospital, Musashino, Tokyo, Japan.
¹³ Department of Emergency Medicine, Jichi Medical University Saitama Medical Center, Omiya, Saitama, Japan.
¹⁴ Department of Medicine, Nerima Hikarigaoka Hospital, Nerima, Tokyo, Japan.
¹⁵ Department of Medicine, Taito Municipal Taito Hospital, Taito, Tokyo, Japan.
¹⁶ Department of Emergency and Critical Care Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan.
¹⁷ Nanohana Clinic, Ikuno, Osaka, Japan.
¹⁸ Department of Emergency Medicine, Yodogawa Christian Hospital, Higashi Yodogawa, Osaka, Japan.
¹⁹ Department of Sports Medicine, Faculty of Medicine, Juntendo University, Bunkyo, Tokyo, Japan.
²⁰ Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima, Tokyo, Japan.
²¹ Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Sakyo, Kyoto, Japan.
²² Department of General Internal Medicine, Tottori Prefectural Central Hospital, Tottori, Tottori, Japan.
²³ Department of Emergency Medicine, Hyogo Emergency Medical Center, Kobe, Hyogo, Japan.
²⁴ Department of Emergency Medicine, Saiseikai Senri Hospital, Suita, Osaka, Japan.
²⁵ Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Hokkaido, Japan.
²⁶ Department of Intensive Care Medicine, Tokyo Women's Medical University Hospital, Shinjuku, Tokyo, Japan.
²⁷ Department of Emergency and Critical Care Medicine, Toyooka Public Hospital, Toyooka, Hyogo, Japan.
²⁸ Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo, Kyoto, Japan.
²⁹ Department of Anesthesia, Gyoda General Hospital, Gyoda, Saitama, Japan.
³⁰ Department of Anesthesiology and Intensive Care, Gunma University Hospital, Maebashi, Gunma, Japan.
³¹ Department of Medicine, Suwa Central Hospital, Chino, Nagano, Japan.
³² Department of Cardiology, Suwa Central Hospital, Chino, Nagano, Japan.
³³ Department of Emergency and General Internal Medicine, Rakuwakai Marutamachi Hospital, Nakagyo, Kyoto, Japan.
³⁴ Department of Medicine, TMG Muneoka Central Hospital, Shiki, Saitama, Japan.
³⁵ Department of Critical Care, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.
³⁶ Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.
³⁷ Department of Medicine, National Hospital Organization Higashiohmi General Medical Center, Higashiohmi, Shiga, Japan.
³⁸ Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.

^# Contributed equally.

PMID: 37728831
DOI: 10.1007/s00592-023-02181-1

Multicenter Study

Clinical profile of patients with diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome in Japan: a multicenter retrospective cohort study

Kyosuke Takahashi et al. Acta Diabetol. 2024 Jan.

. 2024 Jan;61(1):117-126.

doi: 10.1007/s00592-023-02181-1. Epub 2023 Sep 20.

Authors

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-Ku, Saitama City, Saitama Prefecture, 330-0834, Japan. ktakahashi@cf.em-net.ne.jp.
² Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
³ Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-Ku, Saitama City, Saitama Prefecture, 330-0834, Japan.
⁴ Department of Emergency and Critical Care Medicine, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan.
⁵ Department of Preventive Services, Kyoto University Graduate School of Medicine, Sakyo, Kyoto, Japan.
⁶ Division of Nephrology, Department of Internal Medicine, Okinawa Prefectural Chubu Hospital, Uruma, Okinawa, Japan.
⁷ Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
⁸ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
⁹ Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan.
¹⁰ Department of Emergency Medicine, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan.
¹¹ Department of Emergency Medicine, Kumamoto Red Cross Hospital, Higashi, Kumamoto, Japan.
¹² Department of Emergency Medicine, Musashino Red Cross Hospital, Musashino, Tokyo, Japan.
¹³ Department of Emergency Medicine, Jichi Medical University Saitama Medical Center, Omiya, Saitama, Japan.
¹⁴ Department of Medicine, Nerima Hikarigaoka Hospital, Nerima, Tokyo, Japan.
¹⁵ Department of Medicine, Taito Municipal Taito Hospital, Taito, Tokyo, Japan.
¹⁶ Department of Emergency and Critical Care Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan.
¹⁷ Nanohana Clinic, Ikuno, Osaka, Japan.
¹⁸ Department of Emergency Medicine, Yodogawa Christian Hospital, Higashi Yodogawa, Osaka, Japan.
¹⁹ Department of Sports Medicine, Faculty of Medicine, Juntendo University, Bunkyo, Tokyo, Japan.
²⁰ Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima, Tokyo, Japan.
²¹ Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Sakyo, Kyoto, Japan.
²² Department of General Internal Medicine, Tottori Prefectural Central Hospital, Tottori, Tottori, Japan.
²³ Department of Emergency Medicine, Hyogo Emergency Medical Center, Kobe, Hyogo, Japan.
²⁴ Department of Emergency Medicine, Saiseikai Senri Hospital, Suita, Osaka, Japan.
²⁵ Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Hokkaido, Japan.
²⁶ Department of Intensive Care Medicine, Tokyo Women's Medical University Hospital, Shinjuku, Tokyo, Japan.
²⁷ Department of Emergency and Critical Care Medicine, Toyooka Public Hospital, Toyooka, Hyogo, Japan.
²⁸ Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kamigyo, Kyoto, Japan.
²⁹ Department of Anesthesia, Gyoda General Hospital, Gyoda, Saitama, Japan.
³⁰ Department of Anesthesiology and Intensive Care, Gunma University Hospital, Maebashi, Gunma, Japan.
³¹ Department of Medicine, Suwa Central Hospital, Chino, Nagano, Japan.
³² Department of Cardiology, Suwa Central Hospital, Chino, Nagano, Japan.
³³ Department of Emergency and General Internal Medicine, Rakuwakai Marutamachi Hospital, Nakagyo, Kyoto, Japan.
³⁴ Department of Medicine, TMG Muneoka Central Hospital, Shiki, Saitama, Japan.
³⁵ Department of Critical Care, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.
³⁶ Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.
³⁷ Department of Medicine, National Hospital Organization Higashiohmi General Medical Center, Higashiohmi, Shiga, Japan.
³⁸ Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.

^# Contributed equally.

PMID: 37728831
DOI: 10.1007/s00592-023-02181-1

Abstract

Introduction: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS) are life-threatening complications of diabetes mellitus. Their clinical profiles have not been fully investigated.

Methods: A multicenter retrospective cohort study was conducted in 21 acute care hospitals in Japan. Patients included were adults aged 18 or older who had been hospitalized from January 1, 2012, to December 31, 2016 due to DKA or HHS. The data were extracted from patient medical records. A four-group comparison (mild DKA, moderate DKA, severe DKA, and HHS) was performed to evaluate outcomes.

Results: A total of 771 patients including 545 patients with DKA and 226 patients with HHS were identified during the study period. The major precipitating factors of disease episodes were poor medication compliance, infectious diseases, and excessive drinking of sugar-sweetened beverages. The median hospital stay was 16 days [IQR 10-26 days]. The intensive care unit (ICU) admission rate was 44.4% (mean) and the rate at each hospital ranged from 0 to 100%. The in-hospital mortality rate was 2.8% in patients with DKA and 7.1% in the HHS group. No significant difference in mortality was seen among the three DKA groups.

Conclusions: The mortality rate of patients with DKA in Japan is similar to other studies, while that of HHS was lower. The ICU admission rate varied among institutions. There was no significant association between the severity of DKA and mortality in the study population.

Trial registration: This study is registered in the UMIN clinical Trial Registration System (UMIN000025393, Registered 23th December 2016).

Keywords: Diabetes; Epidemiology; Hyperglycemic crisis; Hyperglycemic emergencies; Intensive care; Prognosis.

PubMed Disclaimer

References

1. Kitabchi AE, Umpierrez GE, Murphy MB, Kreisberg RA (2006) Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American diabetes association. Diabetes Care 29:2739–2748. https://doi.org/10.2337/dc06-9916 - DOI - PubMed
1. French EK, Donihi AC, Korytkowski MT (2019) Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients. BMJ. https://doi.org/10.1136/bmj.l1114 - DOI - PubMed
1. Pasquel FJ, Umpierrez GE (2014) Hyperosmolar hyperglycemic state: a historic review of the clinical presentation, diagnosis, and treatment. Diabetes Care 37:3124–3131. https://doi.org/10.2337/dc14-0984 - DOI - PubMed - PMC
1. Dhatariya KK, Nunney I, Higgins K et al (2016) National survey of the management of diabetic ketoacidosis (DKA) in the UK in 2014. Diabet Med 33:252–260. https://doi.org/10.1111/dme.12875 - DOI - PubMed
1. Fathallah N, Slim R, Larif S et al (2015) Drug-induced hyperglycaemia and diabetes. Drug Saf 38:1153–1168. https://doi.org/10.1007/s40264-015-0339-z - DOI - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
- Springer
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Clinical profile of patients with diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome in Japan: a multicenter retrospective cohort study

Affiliations

Clinical profile of patients with diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome in Japan: a multicenter retrospective cohort study

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical