Diabetic Ketoacidosis In Type Research Articles

406-P: Kidney Disease and Risk of Diabetic Ketoacidosis in Type 1 Diabetes

406-P: Kidney Disease and Risk of Diabetic Ketoacidosis in Type 1 Diabetes

Decreased antioxidant capacity in children with diabetic ketoacidosis

Objective. To analyze the levels of antioxidant enzyme superoxide dismutase (SOD) and glutathione peroxidase (GP) against the background of diabetic ketoacidosis (DKA) in type 1 diabetes mellitus (DM) children and adolescents. Materials and methods. The study involved examination of 74 children: 50 DKA children (study group) and 24 relatively healthy children (control group). The study group children were divided into two subgroups: subgroup 1 included children with DKA against the background of type 1 DM onset (n=27), subgroup 2 consisted of children with DKA against the background of chronic type 1 DM (n=23). SOD and GP concentrations in blood plasma were determined in all children by enzyme immunoassay. The reliability between the data was estimated using the Mann-Whitney test, Kruskal-Wallis test and Spearman coefficient. Results. A significant decrease in SOD and GP in children with DKA was revealed as follows: 13130 [13005–18255] Pg/ml and 50.085 [42.02–70.325] Ng/ml, compared to controls: 16415 [13370–19935] Pg/ml and 84.695 [52.49–144.5] Ng/ml, respectively. Minimal SOD and GP were noted in patients with DKA at the background of chronic type 1 DM, compared to DM onset children. The study indicates a reliable correlation between age, duration of the disease, number of DKA in the history and low values of SOD and GP. Conclusion. Decreased antioxidant capacity was found in children with DKA in type 1 DM. SOD and GP can be considered in pediatric practice as markers of oxidative stress in DKA. In addition, an early detection of SOD and GP contributes to the efficient therapy of DKA in children and adolescents.

Diabetic Ketoacidosis in Type 1 Diabetes Onset in Latin American Children

ObjectiveTo describe the patterns of diabetic ketoacidosis (DKA) occurrence in children newly diagnosed with type 1 diabetes (T1DM) across several Latin American pediatric diabetes centers from 2018 to 2022. MethodsA retrospective chart review included children under 18 with new-onset T1DM from 30 Latin American pediatric diabetes centers (Argentina, Chile, and Peru) between 30 December 2018 and 30 December 2022. Multiple logistic regression models examined the relationships between age, gender, medical insurance, BMI, and DKA at new-onset T1DM. As far as we know, there are no large studies in Latin American countries exploring the patterns of DKA in new-onset T1DM. ResultsA total of 2,026 (983 females) children, median age 9.12 (5.8 -11.7) years with new-onset-T1DM were included. Approximately 50% had no medical insurance. Mean glucose values were 467 mg/dL, pH 7.21, bicarbonate 13 mEq/L, HbA1c 11.3%, and BMI 18. The frequency of DKA was 1,229 (60.7%), out of which only 447 (36%) were severe. There was a significant decrease in the frequency of DKA as age increased: 373 (70.2%) in children under 6, 639 (61.6%) in those between 6 and 12, 217 and (47.5%) in those over 12. Children with medical insurance (58.8%) had a significantly lower frequency of DKA than those without (62.7%). The multiple logistic regression models showed that DKA was significantly and inversely associated with age [OR, 0.72 (95% CI 0.60–0.86)], BMI [OR, 0.95 (95% CI 0.92–0.99)], and medical insurance [OR, 0.75 (95% CI 0.60–0.94)] adjusted for sex. ConclusionLatin American children with new-onset T1DM exhibited a substantial occurrence of DKA. Younger ages and the lack of medical insurance were significantly associated with DKA in new-onset T1DM.

Gastric emptying during and following resolution of moderate diabetic ketoacidosis in type 1 diabetes: a case series

IntroductionTo use the ‘gold standard’ technique of scintigraphy to quantify gastric emptying (GE) as soon as practicable during an admission with diabetic ketoacidosis (DKA) and following its resolution at least...

THU360 Hyperglycemic DKA In Patient On Monotherapy With SGLT-2 Inhibitor

Abstract Disclosure: S. Ahmed: None. L. Medina Mora: None. A. Sanchez Ruiz: None. L. Poretsky: None. Background: SGLT2 inhibitors have a rare but increasingly reported risk of euglycemic diabetic ketoacidosis. Hyperglycemic diabetic ketoacidosis is not an expected risk of SGLT-2 inhibitors. Clinical Case: 52-year-old male with history of type 2 Diabetes presented with progressive weakness, shortness of breath, nausea and vomiting worsening over 48 hours. He reported increased polydipsia and polyuria. Patient was found to have a blood glucose of 685 mg/dL associated with an anion gap of 28 mm/L and bicarbonate level of 6 mm/L. Beta hydroxybutyrate level was >8.0 mmoL/L. He was diagnosed with hyperglycemic diabetic ketoacidosis, given intravenous isotonic fluid and started on an insulin drip. The anion gap closed and he was successfully transitioned off the insulin drip to a basal bolus regimen of insulin. The patient improved quickly without any complication. The patient was never on insulin therapy prior to admission. No obvious source of infection was discovered to precipitate the event. The patient had a 7-year history of diabetes and was only managed on oral medications at home. He was previously on Janumet 50-1000mg twice a day and changed to only dapagliflozin 10mg 9 months prior to the current episode. He never experienced ketoacidosis or hyperosmolar hyperglycemic state. Hemoglobin A1c was found to be 8.0%. He reported that his A1c levels were always less than 8%. Autoimmune workup for type 1 Diabetes was done. C-peptide level was found to be 1.5ng/mL. Patient appeared to have an adequate insulin level despite the recent event of diabetic ketoacidosis. Patient was discharged on 10 units of Glargine® at bedtime and 3 units of Lispro® before meals. He was given glucometer teaching with an appointment for endocrine follow up. During follow up Glutamic Acid decarboxylase, Islet cell, Insulin and Zinc 8 transporter antibodies have come back negative. Patient is being planned for transition to oral antihyperglycemic agents which will not include an SGLT2 inhibitor. A MODY panel is pending results for further evaluation. Conclusion: Monotherapy of SGLT-2 inhibitors appears to not only have a risk of euglycemic diabetic ketoacidosis but also a risk of hyperglycemic diabetic ketoacidosis in type 2 diabetics. In this case we presented a case of hyperglycemic diabetic ketoacidosis in a type 2 diabetic on therapy with dapagliflozin. Presentation: Thursday, June 15, 2023

Clinical Outcomes of Diabetic Ketoacidosis in Type 2 Diabetes Patients with and without SGLT2 Inhibitor Treatment: A Retrospective Study.

This study aimed to compare the clinical course and outcomes of DKA in T2DM patients who received treatment with SGLT2 inhibitors versus those who did not. A retrospective analysis was conducted on T2DM patients who were admitted to the Rambam Health Care Campus with DKA between 7/2015 and 9/2020. Demographic, clinical, and laboratory data were obtained from electronic medical records. Outpatient mortality was monitored until 12/2022. Of 71 T2DM patients admitted with DKA, 16 (22.5%) were on SGLT2 inhibitor treatment upon admission. SGLT2 inhibitor users had a higher BMI and were less likely to be treated with insulin. During hospitalization, the rates of acute kidney injury, concomitant infections, and inpatient mortality among SGLT2 inhibitor users were comparable to non-users. The median follow-up period was 35.1 months for the SGLT2 inhibitor users and 36.7 months for non-users. The long-term mortality from any cause was lower among the SGLT2 inhibitor users (12.5% vs. 52.7%, p = 0.004). In Cox regression analysis, SGLT2 inhibitor use was associated with a lower risk of long-term mortality from any cause (HR = 0.19, p = 0.04). T2DM patients with DKA who received SGLT2 inhibitors had lower long-term mortality from any cause compared to those who did not receive SGLT2 inhibitors.

Unexpected cause of recurrent diabetic ketoacidosis in type 1 diabetes: a case report

BackgroundGastrointestinal (GI) symptoms are commonly observed in patients with diabetic ketoacidosis (DKA), which usually resolves completely with therapy. However, GI symptoms can persist after DKA resolves, which can pose diagnostic and management challenges for physicians, especially when dealing with an exceptional diagnosis such as cannabinoid hyperemesis syndrome (CHS).Case presentationIn this case report, we present a patient with type 1 diabetes who had been treated for DKA 6 times in the past year and was eventually diagnosed with CHS.ConclusionIn conclusion, this case demonstrates that a presumptive and incorrect diagnosis can mislead physicians, especially when dealing with challenging diagnoses. Therefore, patients with type 1 diabetes with unusual presentations, such as unexpectedly high pH and bicarbonate levels, with hyperglycemic ketosis should be screened for illicit drug use, especially cannabis.

Neutrophil to lymphocyte ratio is associated with diabetic ketoacidosis in type 1 diabetes mellitus

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Assessment of the Factors That Can Predict the Occurrence of Diabetic Ketoacidosis in Type 1 Diabetic Patients

Background: Diabetes ketoacidosis (DKA) is a common acute complication seen in patients with diabetes mellitus (DM) type 1. It is avoidable by following a good management plan. The risk factors that have been previously identified for DKA are female gender, age, illiteracy, low socio-economic status, infection, poor metabolism, psychological issues, and poor compliance with the treatment. Objective: The present study aims at the determination of age, gender, socio-economic status, DKA at the time of initial diagnosis of DM type 1, parental education regarding the disease, psychological issues, infection, metabolic control, and poor compliance with insulin treatment as the predictive factors of DKA occurrence. Study design: A retrospective cohort study Place and Duration: This study was conducted at GMMC Teaching Hospital Sukkur from November 2021 to November 2022 Methodology: The present study was conducted by using the medical records of patients with DM type 1. The mean age of the patients was 18.2±5.31 with a range of 0-21 years. The data were assessed for the predictive factors of DKA. The dependent variable in the study was DKA occurrence. The independent variables were, compliance with the treatment with insulin, DM type 1, age, infection, psychological issues, metabolic control, parental education, socio-economic status, and diagnosis of DM type 1 on a DKA attack. Logistic regression analysis was done the determination the factors that seemed to increase the incidence of DKA. Results: A total of 42 patients with DM type 1 were included in the study. The incidence of DKA was 27 (64.29%) and 4 (9.52%) of these patients died. Multivariate analysis showed that infection and diagnosis of DM type 1 at the time of DKA were the most significant predictive factors for DKA. Conclusion: Diagnosis of DM type 1 at the time of DKA and infection are the most important factors for increasing the incidence of DKA. Keywords: Diabetic ketoacidosis, type 1 diabetes mellitus, infection, predictive factors

Clinical profile and outcome of critically ill COVID-19 patients with diabetic ketoacidosis: A single-centre cross-sectional study in South India.

Clinical profile and outcome of critically ill COVID-19 patients with diabetic ketoacidosis: A single-centre cross-sectional study in South India.

Severity of new-onset type 1 diabetes in children and adolescents during the coronavirus-19 disease pandemic

Introductionß-pancreatic cells are susceptible to SARS-CoV-2 infection and replication; this could lead to infection-related diabetes or precipitate the onset of type 1 diabetes. This study aimed to determine the severity at diagnosis, analyzing clinical and epidemiological features at debut in children under 16 years of age in the context of the SARS-CoV-2 pandemic. Material and methodsA retrospective observational multicenter study was carried out in 7 hospitals of the public health network located in the south of our community. The severity at debut is compared with that of the two previous years (2018 and 2019). The level of statistical significance is set at p<0.05. ResultsIn 2020, 61 patients debuted at the 7 hospital centres. The mean age was 10.1 years (SD: 2.6), 50.8% older than 10 years. The clinical profile at diagnosis was ketoacidosis in 52.5% compared to 39.5% and 26.5% in the previous two years (p<0.01). The mean pH (7.24 vs 7.30/7.30) and excess of bases (−11.9 vs −7.43/−7.9) was lower than in the previous two years, and the glycated haemoglobin higher (11.9 vs 11/10.6), p<0.05. At least 10% of the patients had a positive history of SARS-CoV-2 infection. ConclusionsThere has been an increase in the frequency of diabetic ketoacidosis in type 1 diabetes onset during the first year of the COVID-19 pandemic.

An Unusual Cause of Acidosis in a Man With Clostridium difficile Colitis

An Unusual Cause of Acidosis in a Man With Clostridium difficile Colitis

Precipitating factors of diabetic ketoacidosis in type 1 diabetes patients at a tertiary hospital: a cross-sectional study with a two-time-period comparison.

To evaluate the precipitating factors of diabetic ketoacidosis (DKA) in patients with type 1 diabetes hospitalized through the emergency department of a tertiary hospital. Individuals with type 1 diabetes hospitalized for DKA from January 2005 to March 2010 (first period [P1], n = 75) and from April 2010 to January 2017 (second period [P2], n = 97) were identified through a query of electronic medical records. Data were collected by reviewing medical records. Only the first hospitalization of each participant in each period was included. In P2, 44 patients (45.4%) were women, mean age was 26.2 ± 14.5 years, and 74 patients (76.3%) had a previous diagnosis of type 1 diabetes. Only 1 patient had glycated haemoglobin (HbA1c) below 64 mmol/mol (8.0%). Most patients (62.2%) had had a previous episode of DKA. In P1, non-adherence was the main cause of DKA (38.7%), followed by infection (24.0%). In P2, these rates were 34.0% and 24.7%, respectively; no statistical difference was observed between the two study periods (p = 0.790). Over time, non-adherence remained the main precipitating factor of DKA, followed by infection, and no significant difference was observed between the two study periods. Elevated HbA1c, outside the therapeutic range, indicates suboptimal diabetes care and may explain, at least in part, poor adherence as a precipitating factor of decompensation. Health strategies, such as improved self-management of type 1 diabetes, may contribute to a future reduction in DKA episodes.

860-P: A Territory-Wide Study of SGLT2 Inhibitor–Associated Postoperative Diabetic Ketoacidosis in Type 2 Diabetes Patients

Objective: We aimed to characterize SGLT2 inhibitor (SGLT2i) -associated post-operative diabetic ketoacidosis (DKA) in type 2 diabetes patients. Methods: We analyzed a territory-wide cohort of type 2 diabetes patients who underwent operations during 2015-2020. Patients who had SGLT2i prescriptions within 6 months before operations were assigned to SGLT2i group while others to control group. Inverse probability treatment weighting with propensity scores was used to balance the baseline covariates between two groups. Post-operative DKA was defined by DKA within 30 days post-operatively. Results: In total, 151488 type 2 diabetes adults undergoing elective (3260 SGLT2i users; 105540 controls) and emergency operations (1087 SGLT2i users; 416controls) were included. SGLT2i users who underwent emergency operations had higher incidence of post-operative DKA (24.5/1000 person-years) than elective operations (1.0/1000 person-years; p&amp;lt;0.001) . SGLT2i exposure significantly elevated incidence of post-operative DKA (elective: incidence rate ratio [IRR]=5.57, p&amp;lt;0.001; emergency: IRR=5.37, p&amp;lt;0.001) . Among SGLT2i users, apart from emergency surgery, HbA1c&amp;gt;8% (64mmol/mol) and baseline insulin use increased the risk of post-operative DKA. SGLT2i users who developed post-operative DKA had worse outcomes (mechanical ventilation, intensive care and length of hospitalization; p&amp;lt;0.05) than those who did not. However, implementation of alert in Clinical Management System about perioperative precaution in SGLT2i users did not reduce the risk of post-operative DKA. Conclusion: Preoperative SGLT2i use was associated with increased risks of post-operative DKA in type 2 diabetes, higher among patients who underwent emergency operations than elective ones. Clinicians should be vigilant regarding the high-risk group. Effective strategies to mitigate risks of SGLT2i-associated post-operative DKA are urgently needed given the associated morbidities. Disclosure D.T.W.Lui: None. T.Wu: None. X.Liu: None. C.Au: None. C.Lee: None. M.Fung: None. Y.Woo: None. K.C.Tan: None. C.K.Wong: None.

Gravedad al comienzo de la diabetes tipo 1 en niños y adolescentes durante la pandemia por la enfermedad por coronavirus-19

Introductionß-pancreatic cells are susceptible to SARS-CoV-2 infection and replication; this could lead to infection-related diabetes or precipitate the onset of type 1 diabetes. This study aimed to determine the severity at diagnosis, analyzing clinical and epidemiological features at onset in children under 16 years of age in the context of the SARS-CoV-2 pandemic. Material and methodsA retrospective observational multicenter study was carried out in 7 hospitals of the public health network located in the south of our community. The severity at debut is compared with that of the two previous years (2018 and 2019). The level of statistical significance is set at P<.05. ResultsIn 2020, 61 patients were diagnosed at the 7 hospital centres. The mean age was 10.1 years (SD: 2.6), 50.8% were older than 10 years. The clinical profile at diagnosis was ketoacidosis in 52.5% compared to 39.5% and 26.5% in the previous two years (P<.01). The mean pH (7.24 vs 7.30 / 7.30) and excess of bases (-11.9 vs -7.43 / -7.9) was lower than in the previous two years, and the glycated haemoglobin higher (11.9 vs 11 / 10.6)%, p<0.05. At least 10% of the patients had a positive history of SARS-CoV-2 infection. ConclusionsThere has been an increase in the frequency of diabetic ketoacidosis in type 1 diabetes onset during the first year of the COVID-19 pandemic.

Clinical Profile and Outcome of Diabetic Ketoacidosis in Type 1 and Type 2 Diabetes: A Comparative Study

Objectives: To Compare the Clinical and Biochemical Profile of DKA in Type 1 and Type 2 DM in terms of various complications and Mortality. Material and Methods: In this comparative study, a total of 95 patients admitted to tertiary care centres with DKA from October 2018 to December 2020, were enrolled. They were analysed for clinical profile and outcome in both groups. Results: Out of 95 patients, Type 1 DM was 18 (18.95%) and 77 (81.05%) were Type 2 DM. Among the clinical presentations, abdominal pain (61.11%) and breathlessness (55.55%) were common in Type 1 DM while breathlessness (40.25%) was the predominant presentation seen in Type 2 DM. There was no significant difference in the biochemical profile of patients in both groups with DKA. The mortality rate was higher in Type 2 DM (12.63%) than Type 1 DM (3.15%). Septicaemic shock (40%) was the most common cause of mortality and the next common was pneumonia in 33%. Severe acidosis, low Glasgow Coma Scale (GCS), high doses and longer duration of insulin therapy, higher acute physiology, and chronic health evaluation II (APACHE-II) score, and high serum osmolality had a bad outcome and were associated with high mortality. Conclusion: DKA is commonly observed in Type 2 DM also. Infection is the most common precipitating factor for DKA. Type 2 DM had the more severe presentation of DKA as compared to Type 1 DM with DKA. Increased APACHE-II, the requirement of insulin, and length of hospital stay are a predictor of mortality. However, GCS, APACHE-II score, and ABG parameters can predict outcomes in DKA.

Clinical Characteristics of Concomitant Diabetic Ketoacidosis in Type 2 Diabetes Patients with Acute Pancreatitis.

ObjectiveThe objective of this retrospective study was to evaluate the clinical characteristics of diabetic ketoacidosis (DKA) in type 2 diabetes mellitus (T2DM) patients with acute pancreatitis (AP) in a cohort from China and to identify simple laboratory parameters to discriminate high-risk patients.MethodsPatients diagnosed with AP and T2DM from January 2015 to December 2020 were retrospectively enrolled. They were divided into DKA group and non-DKA group. We calculated etiologies of AP, compared demographic and clinical features, laboratory findings on admission and clinical course. The receiver operating characteristic (ROC) curve was used to explore the ability of clinical parameters to identify high-risk patients.ResultsA total of 136 patients were enrolled, of which 19.9% (27 patients) concomitant with DKA. Compared with patients without DKA, patients with DKA were younger and more obese with higher levels of serum triglycerides (TGs), blood glucose and hemoglobin A1c (HbA1C). There was a significant difference in etiology between the two groups. Compared with the non-DKA group, the DKA group showed higher rate of HTG, lower rates of gallstones and alcohol abuse. And patients in the DKA group were more likely to be admitted to intensive care unit (ICU) and have longer hospital stays. ROC analyses showed that blood glucose concentration at a cutoff value of 21.75 mmol/L resulted in the highest Youden index with sensitivity and specificity at 81.5% and 94.5%, respectively, for identifying concomitant DKA (AUC = 0.949).ConclusionThe prevalence of concomitant DKA in T2DM patients with AP was 19.9%, concomitant DKA patients tend to be younger, more obese and have higher blood glucose and TGs levels on admission. We found that blood glucose >21.75mmol/L could potentially be used as a simple laboratory parameter to identify high-risk patients.

Diabetic Ketoacidosis in Type 1 DM: A Novel Presentation of CML

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes characterized by metabolic acidosis, hyperglycemia, and ketosis. It most commonly occurs secondary to a precipitating event such as an infection, non-infectious illness, or insulin non-compliance. We report a case of a 28-year-old male with a history of well-controlled type 1 diabetes mellitus who began having frequent and repeated episodes of DKA. Evaluation for compliance lapses was negative. The further review noted a worsening white blood cell count over the same period, despite repeated negative infectious workups. A bone marrow biopsy revealed a hypercellular marrow with granulocyte and megakaryocyte proliferation. Testing for the BCR-ABL fusion gene was positive in 92% of cells. This led to a final diagnosis of chronic myeloid leukemia as the precipitator for repeated presentation with DKA. The two diseases do not commonly present simultaneously due to differences in median age. No previous reports of adults with DKA precipitated by CML are present in the literature. However, worsening hyperglycemia has been reported with other hematologic malignancies, particularly in the setting of acute lymphoblastic leukemia in the pediatric population. This is thought in some instances to be due to the leukemic process itself, potentially through cytokine release.

Diabetic Ketoacidosis and Acute Coronary Syndrome Due to Neck Abscess

Diabetic ketoacidosis (DKA) is a life-threatening consequence of diabetes mellitus. Infection is the most common cause of DKA. A 41-year-old man came to the hospital emergency department with shortness of breath the day before, nausea, vomiting, coughing, pain and swelling in the left neck. The patient has a history of uncontrolled diabetes. A physical examination revealed Kussmaul's breathing and a lump the size of a tennis ball on the left side of his neck. Laboratory findings are: leukocytosis, an increase in blood sugar of 512 mg/dL; blood gas analysis shows acidosis, ketone examination reveals ketonuria; Electrocardiography shows waves of ischemic heart disease, with elevated Hs Troponin. Fine needle examination of the lump shows a neck abscess. The patient was diagnosed with DKA in type 2 diabetes mellitus, with the acute coronary syndrome and neck abscess. Surgical debridement, antibiotics, acute coronary syndrome therapy, and DKA therapy are treatments. The patient responded well to treatment.

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

IntroductionWe 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 methodsThis observational study...