Acute Complications Of Diabetes Mellitus Research Articles

Study On Correlation Of Serum C Reactive Protein (CRP) Levels With Acute Complications Of Diabetes Mellitus In A Tertiary Care Hospital

Study On Correlation Of Serum C Reactive Protein (CRP) Levels With Acute Complications Of Diabetes Mellitus In A Tertiary Care Hospital

Feature selection and risk prediction for diabetic patients with ketoacidosis based on MIMIC-IV.

Diabetic ketoacidosis (DKA) is a frequent acute complication of diabetes mellitus (DM). It develops quickly, produces severe symptoms, and greatly affects the lives and health of individuals with DM.This article utilizes machine learning methods to examine the baseline characteristics that significantly contribute to the development of DKA. Its goal is to identify and prevent DKA in a targeted and early manner. This study selected 2382 eligible diabetic patients from the MIMIC-IV dataset, including 1193 DM patients with ketoacidosis and 1186 DM patients without ketoacidosis. A total of 42 baseline characteristics were included in this research. The research process was as follows: Firstly, important features were selected through Pearson correlation analysis and random forest to identify the relevant physiological indicators associated with DKA. Next, logistic regression was used to individually predict DKA based on the 42 baseline characteristics, analyzing the impact of different physiological indicators on the experimental results. Finally, the prediction of ketoacidosis was performed by combining feature selection with machine learning models include logistic regression, XGBoost, decision tree, random forest, support vector machine, and k-nearest neighbors classifier. Based on the importance analysis conducted using different feature selection methods, the top five features in terms of importance were identified as mean hematocrit (haematocrit_mean), mean hemoglobin (haemoglobin_mean), mean anion gap (aniongap_mean), age, and Charlson comorbidity index (charlson_comorbidity_index). These features were found to have significant relevance in predicting DKA. In the individual prediction using logistic regression, these five features have been proven to be effective, with F1 scores of 1.000 for hematocrit mean, 0.978 for haemoglobin_mean, 0.747 for age, 0.692 for aniongap_mean and 0.666 for charlson_comorbidity_index. These F1 scores indicate the effectiveness of each feature in predicting DKA, with the highest score achieved by mean hematocrit. In the prediction of DKA using machine learning models, including logistic regression, XGBoost, decision tree, and random forest demonstrated excellent results, achieving an F1 score of 1.000. Additionally, by applying feature selection techniques, noticeable improvements were observed in the experimental performance of the support vector machine and k-nearest neighbors classifier. The study found that hematocrit, hemoglobin, anion gap, age, and Charlson comorbidity index are closely associated with ketoacidosis. In clinical practice, these five baseline characteristics should be given with the special attention to achieve early detection and treatment, thus reducing the incidence of the disease.

Incidence and determinants of diabetic ketoacidosis among people with diabetes in Woldiya comprehensive specialized hospital, Ethiopia: a retrospective cohort study

IntroductionDiabetic ketoacidosis is an acute complication of diabetes mellitus that is characterised by hyperglycemia, acidosis, and ketonuria. Diabetes is the most challenging public health problem in the twenty-first century for both developed and developing countries.ObjectiveTo assess the incidence of Diabetic ketoacidosis and its determinants among adult people with diabetes at an Ethiopian Hospital.MethodAn institution-based retrospective cohort study was conducted among 390 adult people with diabetes attending services at Wolida Comprehensive Specialized Hospital. The consecutive sampling method was used to select study participant charts. Data were collected using a checklist prepared from different literature. The data were entered into EPI data version 4.6.0.5 and exported to STATA version 14.0 for further analysis. The Wiebull model was the best fitted model that was selected using the log-likelihood ratio method and the Akakian information criterion. Hazard ratios with their 95% confidence interval and p-value were computed.ResultFrom the total 405 charts reviewed, 390 adult charts were included for analysis. A total of 121 DKA occurred from 5471 person–months of observation. The overall incidence rate of diabetic ketoacidosis was found to be 2.2 per 100 person-months (95% CI: 1.8- 2.6). Being urban dweller (AHR: 0.59, 95% CI: 0.36–0.99), having no family history of DM (AHR: 0.55, 95%CI: 0.31—0.97), presence of infection (AHR: 2.60, 95%CI = 1.06–6.39), having of any comorbidities (AHR: 4.31, 95% CI: 1.70–10.90), and having poor glycemic control (AHR: 7.45, 95% CI: 3.84–14.47) were significant determinants.Conclusion and recommendationsThe overall incidence of diabetic ketoacidosis in study area was relatively high. Poor glycemic control, the presence of infection, and comorbidity were determinants of diabetic ketoacidosis. There is a need to have close follow-up of people with diabetes who have comorbidity, infection, and poor glycemic control.

Seasonal Variation of Diabetic Ketoacidosis in Nangarhar University Teaching Hospital

Diabetic ketoacidosis is a life threating acute complication of diabetes mellitus aquiring special care. The aim of the study was to find out seasonal variation in the prevalence of diabetic ketoacidosis in diabetic patients. It was a cross sectional hospital based study conducted over both male and female diabetic patients admitter at the internal medicine ward of Nangarhar University Teaching Hospital during one year. Mean age across DKA was 53.9 ± 14 for DKA negative patients versus 51.3 ± 17.2 for DKA positive patients, P value = 0.26. Winter season was demonstrated with peak DKA positive cases 21 (43.7%) followed by fall 6 (22.2%), summer 11 (12.2%) and spring 10 (10.3%), respectively (P value = 0.01). Common associated factors included infection (72.2%), ischemia (8.2%), insulin withdrawal (7.7%), and others (6.9%) though not statistically different across seasons. There was significant seasonal variation in the prevalence of diabetic ketoacidosis denoting winter season with peak diabetic ketoacidosis. In fact, infection followed by ischemia and insulin withdrawal was the leading associated factor contributing to the prevalence of diabetic ketoacidosis. Season specific special attention should be paid the relevant symptoms of diabetic ketoacidosis for the early detection and treatment of the disease in order to avoid morbidity and mortality.

Complications of Diabetes Mellitus: A Review Article

Introduction: Diabetes Mellitus is a chronic disease that will be suffered for a lifetime so the progressive disease will continue and can cause complications. Diabetes mellitus usually progresses slowly with symptoms that are mild to severe and can even cause death due to acute or chronic complications.
 
 Content: Hyperglycemic crisis is one of the acute complications that can occur in Diabetes mellitus, both type 1 and type 2. This situation is a serious complication that may occur even in well-controlled diabetes mellitus.
 Conclusion: Diabetic ketoacidosis and hyperglycemic Hyperosmolar State are acute complications of Diabetes mellitus. Both of these complications can be triggered due to inadequate insulin therapy and the presence of infection. Diabetic ketoacidosis is a condition characterized by metabolic acidosis due to excessive formation of ketones, while a hyperglycemic hyperosmolar state is characterized by severe hyperosmolality with serum glucose levels which are usually higher than diabetic ketoacidosis.

Extreme hypernatraemia and rhabdomyolysis in a child with hyperosmolar hyperglycaemic state mixed with diabetic ketoacidosis

Abstract Diabetic ketoacidosis (DKA) is present at diagnosis for about 40% of children with type 1 diabetes mellitus (DM).1 Hyperosmolar hyperglycaemic state (HHS) is another acute complication of DM more typically associated with type 2 DM in adults or adolescents. Recent evidence indicates that a mixed picture of HHS and DKA also occurs in children with type 1 DM2 but it is not frequently reported and therefore at risk of under‐recognition.Here, we report a rare case of HHS mixed with DKA as the first presentation for type 1 DM in a five‐year‐old child with underlying neurodevelopmental problems. Failure to recognise the HHS aspects led to severe hypernatraemia, hyperosmolarity, acute renal impairment and rhabdomyolysis but ultimately the child made a full recovery. This case highlights the importance of early recognition and potential pitfalls in management of mixed HHS with type 1 DM. Copyright © 2023 John Wiley & Sons.

Profil Pasien Ketoasidosis Diabetikum di Rumah Sakit Rujukan Tersier di Bali, Indonesia

Introduction. Diabetic ketoacidosis (DKA) is one of life-threatening acute complication of diabetes mellitus (DM) characterized by hyperglycemia, ketosis, and acidosis. The prevalence of DM is increasing, therefore the incidence of DKA is predicted to continue to increase. The aim of this study was to obtain the profile of DKA patients in RSUP Prof. Dr. IGNG. Ngoerah (RSPN), Denpasar, Bali as a tertiary refferal hospital of Bali and Nusa Tenggara region. Methods. This study was a cohort retrospective study. All patients aged 18 years or older with a diagnosis of DKA during Januari 2022 to February 2023 at RSPN, were included in this study. Data were obtained from medical records then analyzed using the SPSS version 26 program. Results. There were a total of 41 patients with DKA with mean of age was 50,59 (SD 16,87) years, most of them were female (51,2%) and came alone without referral (58,5%). Based on the clinical profile, most patients presented with decreased consciousness (36,5%), infection (90,2%) mostly urinary tract infection (UTI) (40,5%), have a history of insulin use (34,1%), and impaired of renal function (85,4%). The mean of blood glucose was 468,95 (SD 207,78) mg/dL, potassium level 4,19 (SD 1,17) mmol/L, bicarbonate level 12,85 (SD 6,27) mmol/L, and HbA1c 11,5% (7,1-14). The median duration of hospitalization was 7 (1-30) days and 19,5% of them were passed away during treatment, mostly within the first 72 hours. Conclusions. Most patients in this study are female with age less than 60 years. The most common precipitating factor of DKA are UTI and poor glycemic control. A total of 19,5% of patients with DKA were passed away in this study. Thus, clinicians should be more aggressive in the management of DKA, particularly in the first 72 hours.

To study risk factors and biochemical profile of diabetic ketoacidosis patients with special emphasis on serum amylase

Background: Diabetes mellitus (DM) is a complex endocrinological disorder with altered metabolism of blood glucose. Diabetic ketoacidosis (DKA) is one of the life-threatening acute complications of DM that mainly occurs in type 1 diabetes patients, as well as in some patients with type 2 diabetes. The mortality rate associated with DKA depends on the experience of the treating hospital in dealing with this condition; thus, it is critical that patients detect DKA and get medical help as soon as possible. Aims and Objectives: To study risk factors for DKA, clinical and biochemical profile of DKA patients. Correlation between serum amylase level, serum bicarbonate level and mean duration of hospital stay. Materials and Methods: A cross-sectional analytical study was carried out on 100 DKA patients in the Department of Medicine, SGMH Rewa, Madhya Pradesh from January 2021 to June 2022. The data extracted included clinical presentation, precipitating factors, laboratory profile, complications, and hospitalization outcomes. Results: Of the 100 patients admitted for DKA; 70 had type 2 diabetes (70%) and 30 (30%) were type I diabetes. The average age at the time of presentation was 48.61±19.59 years. The commonest precipitating factor was infection (38%) followed by other factors (62%). The most common clinical features at the time of presentation were altered sensorium, fever, vomiting, polyuria, polydipsia, weakness, lethargy, myalgia, headache, anorexia, abdominal pain, and orthopnea. The values for RBS, HCO3, and pH were 525.0±62.4, 12.6±2.69, and 7.14±0.31, respectively. There was no significant difference in clinical and biochemical profile of patients with type 1 and type 2 diabetes. The mortality rate was 3% and factors found to be significant predictors were comorbid condition, severity of mental status, severity of dehydration, RBS at the time of presentation, and severe acidosis. Conclusion: The most common precipitating factors are infection and omission of insulin or irregular treatment. The most common clinical features at the time of presentation are nausea, vomiting, abdominal pain, headache, and dehydration. There is no significant difference in the clinical and biochemical profile of patients with type 1 and type 2 diabetes. The mortality rate in DKA is 3% and the most notable predictors of poor prognosis are; severity of altered sensorium, severity of comorbid condition, severe dehydration, severe acidosis, and identification and treatment of precipitating factors are more important. Patient education plays a crucial role in the prevention of DKA.

Detecting Diabetic Ketoacidosis with Infection: Combating a Life-Threatening Emergency with Practical Diagnostic Tools.

Diabetic ketoacidosis (DKA) is a life-threatening acute complication of diabetes mellitus and can lead to patient demise if not immediately treated. From the recent literature, the diabetic ketoacidosis mortality rate, depending on age, is 2-5%. Insulin discontinuation and infection remain the two most common triggers for diabetic ketoacidosis. About 50% of cases of ketoacidosis result from bacterial infections like urinary tract infections and pneumonia. It is also important to diagnose the presence of infection in diabetic ketoacidosis patients to prevent the excessive use of antibiotics, which may lead to antibiotic resistance. Although performing bacterial culture is confirmatory for the presence or absence of bacterial infection, the time required to obtain the result is long. At the same time, emergency treatment needs to be started as early as possible. This narrative review examines various septic markers to identify the appropriate tools for diagnosis and to distinguish between diabetic ketoacidosis with and without infection. Electronic databases were searched using the Google engine with the keywords "Diabetes Mellitus", "Diabetic Ketoacidosis", "Infection with Diabetic Ketoacidosis", "biomarkers for infection in Diabetic Ketoacidosis", "Procalcitonin", "Inflammatory cytokines in DKA", "Lactic acidosis in DKA", and "White blood cell in infection in DKA". This narrative review article presents the options for diagnosis and also aims to create awareness regarding the gravity of diabetic ketoacidosis with infection and emphasizes the importance of early diagnosis for appropriate management. Diabetes mellitus is a clinical condition that may lead to several acute and chronic complications. Acute diabetic ketoacidosis is a life-threatening condition in which an excess production of ketone bodies results in acidosis and hypovolemia. Infection is one of the most common triggers of diabetic ketoacidosis. When bacterial infection is present along with diabetic ketoacidosis, the mortality rate is even higher than for patients with diabetic ketoacidosis without infection. The symptoms and biomarkers of diabetic ketoacidosis are similar to that of infection, like fever, C reactive protein, and white blood cell count, since both create an environment of systemic inflammation. It is also essential to distinguish between the presence and absence of bacterial infection to ensure the appropriate use of antibiotics and prevent antimicrobial resistance. A bacterial culture report is confirmatory for the existence of bacterial infection, but this may take up to 24 h. Diagnosis needs to be performed approximately in the emergency room upon admission since there is a need for immediate management. Therefore, researching the possible diagnostic tools for the presence of infection in diabetic ketoacidosis patients is of great importance. Several of such biomarkers have been discussed in this research work.

Diabetic Ketoacidosis among Diabetic Patients Admitted in the Department of Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Diabetic ketoacidosis is one of the most severe acute complications of diabetes mellitus characterised by hyperglycemia, hyperketonemia, and metabolic acidosis. Prompt diagnosis and treatment of diabetic ketoacidosis can decrease severity, hospital stay, and possible mortality. This study aimed to find out the prevalence of diabetic ketoacidosis among diabetic patients admitted to the department of medicine of a tertiary care centre. This descriptive cross-sectional study was conducted at a tertiary care centre. Data from 1 March 2022 to 1 December 2022 were collected between 1 January 2023 and 1 February 2023 from the hospital records. The ethical approval was taken from the Institutional Review Committee of the same institute (Reference number: 466/2079/80). All the diabetic patients admitted to the Department of Medicine during our study duration were enrolled for the study. Diabetic patients who left against medical advice and those with incomplete data were excluded from the study. Data were collected from the medical record section. Convenience sampling method was done. Point estimate and 95% Confidence Interval were calculated. Among 200 diabetic patients, the prevalence of diabetic ketoacidosis was 7 (3.5%) (3.47-3.53, 95% Confidence Interval) among which 1 (14.29%) patients had type I diabetes mellitus and 6 (85.71%) had type II diabetes mellitus patients and the mean HbA1C level was 9.77%. The prevalence of diabetic ketoacidosis among diabetes mellitus patients admitted to the department of medicine of a tertiary care centre was found to be higher than in other studies done in similar settings. diabetes mellitus; diabetic complications; diabetic ketoacidosis; Nepal.

Современные подходы к управлению гликемией у пациентов с сахарным диабетом

Given the steady increase in the number of patients with diabetes mellitus, the need for sufficient and high-quality glucose monitoring forces researchers worldwide to create and study more and more new methods of managing blood sugar. Currently, continuous glucose monitoring demonstrates the best results. However, the use of modern technologies is not always possible in clinical practice. One of the currently discussed methods is the structured 7-point blood glucose monitoring. Such a self-care option contributes to the greater adherence of patients to treatment, improvement of their life quality, and risk reduction of diabetes acute complications. This article presents an overview of foreign studies devoted to assessing the possibilities of the structured 7-point blood glucose monitoring in practice. We also presented our own data demonstrating the benefits of using glucose meters with a mobile application as part of a modern approach to 7-point blood glucose monitoring for 14 days. It was aimed at effectively reducing the glycated hemoglobin level in patients with type 1 and type 2 diabetes mellitus. KEYWORDS: diabetes mellitus, glucose monitoring, hypoglycemia, hyperglycemia, acute complications of diabetes mellitus, mobile application. FOR CITATION: Chernikova N.A., Grigorieva M.A. Modern methods aimed at glycemia management in patients with diabetes mellitus. Russian Medical Inquiry. 2023;7(9):592–597 (in Russ.). DOI: 10.32364/2587-6821-2023-7-9-6.

Precomatosis condition as a factor of violent death in patients with diabetes mellitus: a rare case report

BACKGROUND: Diabetic coma is a common diabetes mellitus complication. The study of carbohydrate status is usually conducted with non-violent death; however, the death of patients with diabetes can occur with various types of violent death. This study aimed to describe and analyze rare expert cases of the circumstances of violent death in patients with diabetes mellitus.
 CASE PRESENTATION: This publication presents two cases of the violent death of patients with diabetes mellitus, of which the cause was a precomatous state, which is the beginning of diabetic (hyperglycemic) coma development. The first case was a corpse of a 56-year-old male patient who was found in an apartment in a bathtub with water. The patient died from drowning in freshwater by aspiration. The second case was a 62-year-old male patient who lost control of the car and allowed the vehicle to overturn. The patient died due to a closed craniocerebral injury of the body. In both described cases, the provoking factor was an acute complication of diabetes mellitus in the form of diabetic coma development (precomatosis condition), which was confirmed by the data of a biochemical study of blood, urine, and the vitreous body.
 CONCLUSION: One should not forget about the acute complications of diabetes mellitus (diabetic comas) due to its widespread among the population, which can become provoking factors for the onset of violent death. Therefore, conducting a complete laboratory study on patients with diabetes mellitus, even under any circumstances of the case, is recommended.

Hyperglycemic hyperosmolar state in children: a case series

Background: Hyperglycemic hyperosmolar state (HHS) is a life-threatening rare acute complication of diabetes mellitus (DM). The condition should be distinguished from diabetic ketoacidosis (DKA) as the management differs significantly. HHS is classically associated with type 2 DM, but it has been increasingly reported in type I DM as well. The literature regarding HHS in children is still sparse. The management of HHS in children is extrapolated from the adult study. Cases: The first case was male 5 years old, and the second case was female 15 years old. Both cases were typed 1 DM patient. The first case was newly diagnosed. Both of the patients came with general weakness, mild dehydration, overly high blood sugar, normal blood pH, hypocalcemia, glucosuria and only mild ketonuria. In the second case develop, both patients were rehydrated, given insulin and discharged in 7-10 days without any sequelae. Conclusion: These case series emphasize the importance of recognizing HHS and differ it from DKA. These two cases prove that HHS is increasingly reported in children with clinical symptoms resembling DKA. It is also proven that with early diagnosis and correct management, children with HHS can be discharged home without any sequelae.

Outcome of diabetic ketoacidosis among paediatric patients managed with modified DKA protocol at Tikur Anbessa specialized hospital and Yekatit 12 hospital, Addis Ababa, Ethiopia.

IntroductionDiabetic ketoacidosis (DKA) is a serious acute complication of diabetes mellitus that carries a significant risk of mortality with delayed treatment in low‐resource countries. This study aimed to determine the outcome of paediatric DKA patients' managed with a modified DKA treatment protocol using intermittent bolus subcutaneous insulin administration.MethodsA cross‐sectional study design with retrospective data collection was conducted among children younger than 14 years of age admitted from January 2013 to February 2017. A modified protocol was prepared based on a reference from the international society for paediatric and adolescent diabetes and other international guidelines. Data were analysed using Statistical package for social science (SPSS) version 22.0. Descriptive statistics were performed. Binary logistic regression was used to identify associations, and significant variables were further considered for multivariate logistic regression to determine the outcome of DKA patients.ResultAmong the 190 patients, 55.5% (n = 105) were newly diagnosed. The overall average time required for resolution of DKA was 48 ± 27.8 h. Mental status on presentation (p = .001), shock on presentation (p < .01) and severity of DKA (p < .001) were found to have a significant association with the mean time for clearance of DKA. Hypoglycaemia was the most common treatment‐related complication, which occurred in 23.7% of patients (n = 45) followed by hypokalaemia in 4.3% of patients (n = 8), and no patient developed cerebral oedema and death.ConclusionThe time required for clearance of DKA was prolonged, and hypoglyceamia was a common complication for children younger than 5 years of age. The modified protocol of DKA is reasonable management for low‐resource settings with further modification.

Outcomes of Diabetic Ketoacidosis in Adults With End-Stage Kidney Disease: Retrospective Study Based on a National Database

Introduction: The prevalence of diabetes mellitus (DM) in the United States has steadily increased over the past few decades. End-stage kidney disease (ESKD) and diabetic ketoacidosis (DKA) are among the most common chronic and acute complications of DM. Guidance on the management of DKA in ESKD is limited by lack of evidence. We investigated the in-hospital outcomes of patients hospitalized for DKA with underlying ESKD. Methods: We carried out a retrospective cohort study and utilized the National Inpatient Sample (NIS) database from 2016 to 2018. International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10 CM) codes were used to identify adults (>18 yrs) diagnosed with DM and ESKD. We compared patients with DKA and ESKD to patients who had DKA with preserved renal function. The primary outcomes were rates of in-hospital mortality and mechanical ventilation. Results:Out of 538,135 patients, 18,685 (3.74%) represented DKA patients with ESKD, and 519,450 (96.53%) represented DKA patients with preserved renal function. DKA with concomitant ESKD was more prevalent in a relatively older population (age>30 yrs) with female predominance (52.4%) (p<0.001). The mean age of males and females in the ESKD group was 46.2 (SD 12.7) and 43.7 (SD 13.6) years respectively. African American race and low socioeconomic status had a higher burden of ESKD. In-hospital mortality rate (adjusted OR= 1.12, p=0.56) and need for mechanical ventilation (adjusted OR= 1.11, p=0.25) did not differ significantly in the two groups but adjusted mean total hospitalization charge ($14,882) and mean length of stay (0.87) at the hospital were significantly higher in patients with DKA and ESRD than in those with preserved renal function.Conclusion: DKA is associated with short-term morbidity, increased length of stay, and cost of hospitalization. There is a dearth of evidence-based guidance regarding DKA management in CKD and ESRD. Further studies looking into measures in the management of DKA in ESRD will help develop guidelines in management, decreasing morbidity, and cost of hospitalization.

Hypokalemia in Diabetes Mellitus Setting.

Diabetes mellitus is a public health problem that affects millions of people worldwide regardless of age, sex, and ethnicity. Electrolyte disturbances may occur as a consequence of disease progression or its treatment, in particular potassium disorders. The prevalence of hypokalemia in diabetic individuals over 55 years of age is up to 1.2%. In patients with acute complications of diabetes, such as diabetic ketoacidosis, this prevalence is even higher. Potassium disorders, either hypokalemia or hyperkalemia, have been associated with increased all-cause mortality in diabetic individuals, especially in those with associated comorbidities, such as heart failure and chronic kidney disease. In this article, we discuss the main conditions for the onset of hypokalemia in diabetic individuals, briefly review the pathophysiology of acute complications of diabetes mellitus and their association with hypokalemia, the main signs, symptoms, and laboratory parameters for the diagnosis of hypokalemia, and the management of one of the most common electrolyte disturbances in clinical practice.

Morbimortality Analysis of Diabetic Ketoacidosis in a Second Level Hospital in Mexico

Background: Diabetic ketoacidosis (DKA) is a very frequent entity that presents as an acute complication of diabetes mellitus, in which there is a state of hyperglycemia, metabolic acidosis and ketosis. Acute complications of diabetes represent a high percentage of admissions to the emergency department of second level hospitals in Mexico. Methods: This is a retrospective, observational, comparative, cohort and descriptive study with documented analysis technique. We obtained information from a diary of records of the intensive care unit of our hospital and included all patients older than 14 years with a diagnosis of diabetic ketoacidosis. Patients younger than 14 years were excluded as well as hyperosmolar states. Results: Of the 1725 patients admitted to the ICU only 134 had diabetic ketoacidosis; 91% of which were of metabolic origin; 3 patients had acute pancreatitis, and complications were equal to 0.7%, being acute renal injury, urosepsis, preeclampsia and pneumonia. The most frequent age group was between 20 and 30 years old, while mortality was 10%. The incidence of diabetic ketoacidosis was more frequent in the male sex in contrast with the study of Li et al who report a predominance in the female sex. In the age group we agree with Ramphul et al. who determine an average age of 18 to 44 years in the U.S. population. Therefore, we take into account that our casuistry in Mexico is partially similar and that the tendency of diabetic ketoacidosis has been greater in the male population, as well as an increased mortality. Conclusions: In this study involving patients with diabetic ketoacidosis, the incidence and mortality tend to be increasing in our hospital and is that related to economic and sociocultural factors given the fact that our country and hospital of origin is in the means of development.

DETERMINAN INSIDEN HIPOGLIKEMIA PADA PASIEN DIABETES MELLITUS TIPE 2: STUDI LITERATUR

Background: Hypoglycemia occurs when the blood sugar level is &lt;70 mg / dl in the presence of clinical symptoms. This is an acute complication of diabetes mellitus. (Riskesdes 2014), obtained the data that diabetes type 2 is 90% of all diabetes. In 2017, diabetes mellitus in Indonesia increased by 1.4%. As many as 10% -30% had hypoglycemia with a mortality rate of 3% -4% (Diabetes mellitus type 1). Meanwhile, 1.2% incidence in type 2 diabetes mellitus. Therefore, the aim is to investigate the factors that influence the incidence of hypoglycemia in type 2 diabetes mellitus patients. In order to further help improve the optimal management of hypoglycemia. Method: Literature study from 16 international journals with the inclusion criteria of ages 45-90 years, full text journals, and ranges for the years 2016-2020, hypoglycemia, type 2 diabetes. Data based on data published article by NCBI and Google Scholar. Data were analyzed with descriptive analysis. Results: Age, Gender, Use of Sulfonylurea, Knowledge, Body Mass Index, Kidney Function, History of Hypoglycemia, Exercise / Physical Activity, Diet and Diabetes Duration were factors that the researchers found. Conclusion: Data obtained on several factors hypoglycemia. These factors include age, gender, use of sulfonylureas, knowledge of hypoglycemia, body mass index, decreased kidney function, history of hypoglycemia, exercise / physical activity, diet (delaying or skipping meals), and duration of diabetes.&#x0D; &#x0D;

Euglycemic ketoacidosis complicating empagliflozin therapy in a Bangladeshi type 2 diabetic lady

Diabetic ketoacidosis (DKA) is an acute complication of diabetes mellitus, which may occurin both type 1 and type 2 diabetic patients. It is characterized by hyperglycaemia [blood glucose levels &gt; 250 mg/dL (13.8 mmol/ L)], metabolic acidosis (pH &lt;7.3 or serum bicarbonate &lt;15 mmol/L) with an increased anion gap and the presence of ketone bodies in blood or urine. A subgroup of patients may present without signs of hyperglycemia, rather present with euglycemia, posing a diagnostic challenge due to the absence of the cardinal findings of the pathophysiology in DKA. Here, we report a case of euglycemic ketoacidosis complicating a 50-year-old Bangladeshi diabetic lady receiving empagliflozin treatment. BIRDEM Med J 2021; 11(3): 243-245

Seasonality in hyperglycemic emergencies in a Health Facility in Sub-Saharan Africa: The roles of geographic location, infection, and knowledge of diabetes mellitus status

Hyperglycemic emergencies (HEs) are acute complications of diabetes mellitus and they carry high morbidity and mortality. Studies have reported a seasonal pattern in the frequency of occurrence of both types 1 and 2 diabetes mellitus and even Gestational Diabetes Mellitus. No such association has been suggested for HEs. The study was conducted at the Asokoro District Hospital, Located in Abuja, Nigeria to examine a seasonal pattern in the frequency of hyperglycemic emergencies. The initial observation of an obvious fluctuation in the number of admitted cases of hyperglycemic emergencies motivated this prospective study which ran for a period of six years. It involved collecting the relevant information using a questionnaire from all HEs patients admitted to the medical ward from the first of January, 2008 to the 31st of December, 2013. Required investigations were done. The precipitating factors for HEs were looked for. The number of cases per month was noted for each year. The Statistical package used for analysis was STATA version 11. Round the year Abuja Climatic changes were monitored on the website of the Nigerian Meteorological station. Four hundred and fifty-one (451) patients with hyperglycemic emergency were enrolled for this study. Most of the patients, (55%), were in the middle-age bracket. Fifty-six per cent (56%), were not previously known to be living with diabetes mellitus. Infections, particularly of the respiratory and gastrointestinal tracks, were the commonest precipitating factors. Variation in the frequency of HEs was observed, with two peaks: one in April and a smaller peak in December. There is seasonal variation in the frequency of presentation of Hyperglycemic emergencies. This may have been influenced by exogenous factors such as geographic location, infection, and the fact that most of the patients never knew they had diabetes mellitus.