Episodes Of Diabetic Ketoacidosis Research Articles

Budget impact analysis of continuous glucose monitoring in individuals with type 2 diabetes on insulin treatment in England

IntroductionIn 2022, updated guidance from NICE expanded the options for self-monitoring of blood glucose for patients with type 2 diabetes (T2DM), to include continuous glucose monitoring (CGM). In this budget impact analysis, the cost impact of CGM was compared with traditional self-monitoring of blood glucose (SMBG) in adults with T2DM over 1 year from the commissioner perspective in England.Research Design and methodsThe NICE-eligible T2DM cohort was split into 4 subgroups to enable nuanced costing by insulin administration frequency: basal human insulin, premixed insulin, basal-bolus insulin and bolus insulin. The model’s cost components comprised mild and severe hypoglycaemia (SH), diabetic ketoacidosis (DKA), consumables and healthcare resource utilisation in primary and secondary care.ResultsThe introduction of CGM is estimated to be cost additive by approximately £4.6 million in the basecase, driven by increased spending on the CGM device. Overall, healthcare activity was reduced by approximately 20,000 attendances, due to fewer SH and DKA episodes in the CGM arm. General Practitioner (GP) practice-based activity is expected to drop after the first year as patients requiring CGM training is reduced. The budget impact could be neutralised if the CGM sensor was discounted by 13.2% (£29.76 to £25.83).ConclusionsCGM may result in increased spending in the NICE-eligible T2DM cohort but is expected to reduce demand on secondary care services and GP time. These findings may be of interest to local decision-makers who wish to resolve the COVID-19 backlog with transformational investment in primary care to reduce secondary care activity.

Exploring ketoacidosis frequency and risk factors in childhood-onset type 1 diabetes: an 8-year retrospective study (2011-2018) at a tertiary paediatric hospital in Tripoli, Libya.

Diabetic ketoacidosis (DKA) stands as a critical, acute complication of type 1 diabetes. Despite its severity, there exists a dearth of data concerning the frequency and prevalence of DKA at the onset of type 1 diabetes in Libyan children. This study aimed to ascertain the frequency of DKA during the initial presentation of type 1 diabetes among children aged 0.5-14 years admitted to Tripoli Children's Hospital between 2011 and 2018. Employing a retrospective approach, the study examined the proportion of children with newly diagnosed type 1 diabetes who presented with DKA. Data analysis included estimating DKA frequency concerning age at presentation, sex, and age groups. The comparative analysis involved assessing DKA frequency between 0.5 and <2 and 2-14 years age groups. Logistic regression analysis evaluated the impact of age group, sex, and family history of type 1 diabetes on DKA and severe DKA occurrence. Among 497 children with newly diagnosed type 1 diabetes, 39.2 % presented with DKA, of these 44.5 % had severe DKA. Females exhibited a higher DKA rate than males (OR 1.63, 95 % CI 1.13-2.34, p=0.009). Very young children (0.5 to <2 years) presented with DKA more frequently than those aged 2-14 years (OR 4.73, 95 % CI 2.65-8.47, p<0.001), and they were more likely to present in severe DKA (63.9 vs. 39.1 %, [OR 7.26, 95 % CI 3.65-14.41, p<0.001]). The frequency of DKA at type 1 diabetes onset among children admitted to Tripoli Children's Hospital is notably high, with nearly half of the DKA episodes categorized as severe. Very young children notably demonstrated a fivefold increase in the likelihood of presenting with DKA.

Automated Insulin Delivery in Adults With Type 1 Diabetes and Suboptimal HbA1c During Prior Use of Insulin Pump and Continuous Glucose Monitoring: A Randomized Controlled Trial.

Automated insulin delivery (AID) systems offer promise in improving glycemic outcomes for individuals with type 1 diabetes. However, data on those who struggle with suboptimal glycemic levels despite insulin pump and continuous glucose monitoring (CGM) are limited. We conducted a randomized controlled trial to assess the effects of an AID system in this population. Participants with hemoglobin A1c (HbA1c) ≥ 58 mmol/mol (7.5%) were allocated 1:1 to 14 weeks of treatment with the MiniMed 780G system (AID) or continuation of usual care (UC). The primary endpoint was change in time in range (TIR: 3·9-10·0 mmol/L) from baseline to week 14. After this trial period, the UC group switched to AID treatment while the AID group continued using the system. Both groups were monitored for a total of 28 weeks. Forty adults (mean ± SD: age 52 ± 11 years, HbA1c 67 ± 7 mmol/mol [8.3% ± 0.6%], diabetes duration 29 ±13 years) were included. After 14 weeks, TIR increased by 18.7% (95% confidence interval [CI] = 14.5, 22.9%) in the AID group and remained unchanged in the UC group (P < .0001). Hemoglobin A1c decreased by 10.0 mmol/mol (95% CI = 7.0, 13.0 mmol/mol) (0.9% [95% CI = 0.6%, 1.2%]) in the AID group but remained unchanged in the UC group (P < .0001). The glycemic benefits of AID treatment were reproduced after the 14-week extension phase. There were no episodes of severe hypoglycemia or diabetic ketoacidosis during the study. For adults with type 1 diabetes not meeting glycemic targets despite use of insulin pump and CGM, transitioning to an AID system confers considerable glycemic benefits.

Does an episode of diabetic ketoacidosis affect thyroid function tests in pediatric patients?

The aim of our study was to investigate the changes in thyroid hormone levels during and after acute metabolic disorder in patients with diabetic ketoacidosis (DKA). Eighty five patients diagnosed with DKA were included in the study. Patients with control thyroid function test (TFT) values at admission (the first blood sample) and 1month later were included in the study. Thyroid function tests obtained during diabetic ketoacidosis and at the first month follow-up were compared. Euthyroidism and euthyroid sick syndrome were defined and grouped according to current guidelines. The mild and moderate groups, according to DKA classification, were combined and compared with the severe group. A significant increase was observed between the first admission and the control TFT values 1month later. However, there was no significant difference found in TFT between mild/moderate and severe groups taken at the time of DKA. Difference between two groups, euthyroid sick syndrome and euthyroid, was examined and the result that was different from the literature was the difference between TSH levels. We found that low FT4 levels were associated with higher HgbA1c, although the correlation was weak. Thyroid hormone levels may not reflect a thyroid disease during severe DKA attack. Therefore, it is unnecessary to check thyroid function tests.

Household food insecurity and associations with hemoglobin A1c and acute diabetes-related complications in youth and young adults with type 1 diabetes: The SEARCH for diabetes in youth study

AimsTo examine, among youth and young adults (YYA) with type 1 diabetes (T1D), the association of household food insecurity (HFI) with: 1) HbA1c and 2) episodes of diabetic ketoacidosis (DKA) and severe hypoglycemia. MethodsHFI was assessed using the U.S. Household Food Security Survey Module in SEARCH for Diabetes in Youth participants with T1D between 2016 and 2019. Linear and logistic regression models adjusted for age, diabetes duration, sex, race, ethnicity, clinic site, parent/participant education, household income, health insurance, and diabetes technology use. ResultsOf 1830 participants (mean age 20.8 ± 5.0 years, 70.0 % non-Hispanic White), HbA1c was collected for 1060 individuals (mean HbA1c 9.2 % ± 2.0 %). The prevalence of HFI was 16.4 %. In the past 12 months, 18.2 % and 9.9 % reported an episode of DKA or severe hypoglycemia, respectively. Compared to participants who were food secure, HFI was associated with a 0.33 % (95 % CI 0.003, 0.657) higher HbA1c level. Those with HFI had 1.58 (95 % CI 1.13, 2.21) times the adjusted odds of an episode of DKA and 1.53 (95 % CI 0.99, 2.37) times the adjusted odds of an episode of severe hypoglycemia as those without HFI. ConclusionsHFI is associated with higher HbA1c levels and increased odds of DKA in YYA with T1D.

Randomized Trial of Assisted Hybrid Closed-Loop Therapy Versus Sensor-Augmented Pump Therapy in Pregnancy.

Objective: Examine gestational safety, glycemic and health outcomes, of a hybrid closed-loop (HCL) system without pregnancy-specific glucose targets. Research Design: This was a pilot feasibility investigator-initiated, two-site, single-blind, randomized controlled trial of sensor-augmented pump therapy (SAPT) versus HCL therapy in type 1 diabetes pregnancies. Participants were enrolled in the first trimester and randomized at 14-18 weeks of gestation and used SAPT or HCL until 4-6 weeks postpartum. We compared continuous glucose monitoring (CGM) metrics, severe hypoglycemia (SH), diabetic ketoacidosis (DKA), adverse skin reactions, and pregnancy outcomes between groups. Results: Baseline characteristics were similar between groups (n = 11 HCL and n = 12 SAPT). There was no SH or DKA episode after randomization. Time spent <54 mg/dL did not differ between groups. Time spent <63 mg/dL decreased in both groups, significantly in the HCL group (3.5% [1.3% standard error] second trimester and 2.8% [1.3%] third trimester vs. 7.9% [1.3%] run-in phase, P < 0.05 for both). Mean sensor glucose was lower with SAPT compared to HCL therapy in the third trimester (119 [4] mg/dL SAPT vs. 132 [4] mg/dL HCL, P < 0.05). Third trimester time-in-range (TIR; 63-140 mg/dL) increased with SAPT (68.2% [3.1%] vs. 64.3% [3.1%] run-in phase, P < 0.05). Gestational health outcomes did not differ between groups. The HCL group used assistive techniques, such as fake carbohydrate boluses and exiting HCL overnight. Conclusions: CGM within group differences were seen for time <63 mg/dL favoring HCL therapy and TIR favoring SAPT (third trimester vs. baseline). Safety and adverse pregnancy outcomes were similar between groups.

An Automated Insulin Delivery System with Automatic Meal Bolus Based on a Hand-Gesturing Algorithm.

Background: Carbohydrate counting (CC) and meal announcements, before eating, introduce a significant burden for individuals managing type 1 diabetes (T1D). An automated insulin delivery system with automatic bolusing that eliminates the need for CC and premeal bolusing (i.e., a hands-free closed-loop [HFCL] system) was assessed in a feasibility trial of adults with T1D. Methods: The system included the MiniMed™ 780G pump and a smartphone-paired smartwatch with the Klue application (Klue, Inc.) that detects eating and drinking gestures. A smartphone algorithm converted gestures into carb amounts that were transmitted to the pump for automatic bolusing. For 5 days, participants (N = 17, 18-75 years of age) used the system at home with meal announcements based on traditional CC, with the Klue application disabled (Home-stay phase). Thereafter, participants moved to a supervised hotel setting, where the Klue application was enabled for 5 days and meals were not announced (Hotel-stay phase). Participants consumed the same eight test meals (six solid and two liquid) of varying caloric and carb size at the same time and day of the week for both phases, and glycemic metrics were compared. Otherwise, there were no other meal restrictions. Results: The overall time in range (70-180 mg/dL) was 83.4% ± 7.0% and 80.6% ± 6.7% for the Home-stay and Hotel-stay, respectively (P = 0.08). The average time at <70 mg/dL was 3.1% and 3.0% (P = 0.9144), respectively, and the average time at >180 mg/dL was 13.5% and 16.3% (P = 0.1046), respectively. Postprandial glycemia following low-carb test meals was similar between the two phases. The system's ability to accommodate high-carb meals was somewhat limited. There were no episodes of severe hypoglycemia or diabetic ketoacidosis. Conclusion: Preliminary findings show that a HFCL system was safe and maintained overall glycemic control, similar to that observed with traditional CC and manual meal bolusing. By eliminating these daily T1D burdens, a HFCL system may improve quality of life for individuals with T1D. ClinicalTrials.gov number: NCT04964128.

Beta-Hydroxybutyrate Levels and Risk of Diabetic Ketoacidosis in Adults with Type 1 Diabetes Treated with Sotagliflozin.

Sodium glucose cotransporter (SGLT) inhibitors may increase beta-hydroxybutyrate (BHB) in insulin-requiring patients. We determined factors associated with BHB changes from baseline (ΔBHB) and diabetic ketoacidosis (DKA) in patients with type 1 diabetes (T1D) receiving sotagliflozin as an insulin adjunct. This post-hoc analysis compared ΔBHB levels in adults with T1D receiving sotagliflozin 400 mg or placebo for 6 months. We evaluated clinical and metabolic factors associated with ΔBHB and used logistic regression models to determine predictors associated with BHB values >0.6 and >1.5 mmol/L (inTandem3 population; N=1402) or with DKA events in a pooled analysis (inTandem1-3; N=2453). From baseline (median, 0.13 mmol/L), median fasting BHB increased by 0.04 mmol/L (95% confidence interval, 0.03-0.05; P<0.001) at 24 weeks with sotagliflozin vs. placebo; 67% of patients had no or minimal changes in BHB over time. Factors associated with on-treatment BHB >0.6 or >1.5 mmol/L included baseline BHB and sotagliflozin use. Age, insulin pump use, sotagliflozin use, baseline BHB, and ΔBHB were significantly associated with DKA episodes. Independent of treatment, DKA risk increased by 18% with each 0.1-mmol/L increase in baseline BHB and by 8% with each 0.1-mmol/L increase from baseline . Incremental increases in baseline BHB and ΔBHB were associated with higher DKA risk independent of treatment. Adding sotagliflozin to insulin increased median BHB over 24 weeks in patients with T1D and was associated with increased DKA events. These results highlight the importance of BHB testing and monitoring and individualizing patient education on DKA risk, mitigation, identification, and treatment.

Case Report: Diabetic ketoacidosis after co-administration of empagliflozin and probenecid

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are filtered and secreted to their primary site of action in the proximal tubule of the kidney. At this site, SGLT2 inhibitors also reduce renal elimination of ketone bodies, a finding implicated in their propensity to cause ketoacidosis. Many commonly used medications have potential to diminish renal elimination of SGLT2 inhibitors and to compound the effects of SGLT2 inhibitors on renal elimination of ketone bodies by inhibiting tubular secretion of the SGLT2 inhibitor itself and/or ketone bodies. We present a case of severe diabetic ketoacidosis (DKA) in a patient with type 2 diabetes occurring several days after co-prescription of empagliflozin and probenecid. Other than the recent introduction of empagliflozin, no cause for the DKA episode was apparent. A pharmacokinetic interaction between probenecid and empagliflozin, involving organic anion transporter 3 (OAT3), reduces proximal tubular secretion of empagliflozin and increases patient exposure to the drug. Whether or not this phenomenon is sufficient to cause severe DKA is discussed. An alternative explanation as to the DKA aetiology is proposed, wherein probenecid may compound effects of empagliflozin on renal elimination of ketone bodies. We suggest that clinicians exercise caution when prescribing SGLT2 inhibitors alongside pharmacologic inhibitors of, or competitors for, proximal tubular organic anion transporters in patients with diabetes mellitus due to the risk of severe DKA.

Quality of life in pediatric patients suffering from Type 1 Diabetes Mellitus. Comparative study of the reports of young patients and their parents

Background: For the effective management of type 1 diabetes, patients are called upon to adopt changes in lifestyle, diet, and exercise. However, it appears that living with diabetes often disrupts their quality of life. Methods: The study involved recording reports from pediatric patients with type 1 diabetes aged 5-18 years, as well as their parents, to assess the quality of life of the affected individuals. The questionnaire used was the PedsQL Diabetes Module Version 3.0, which evaluates: the symptoms of type 1 diabetes, treatment-related issues, concerns about the disease, and communication. Results: The study sample consisted of 102 patients with type 1 diabetes. The collected data revealed that living with the disease affects the quality of life. Some indicative examples of this would be how high levels of HbA1c and episodes of hypoglycemia or diabetic ketoacidosis, can complicate the lives of patients who suffer from type 1 diabetes. Additionally, the quality of life depends on various demographic factors, such as father's educational level, presence of siblings in the family, place of residence, and age of the patients. Conclusions: Although this study has some limitations, it is evident that living with type 1 diabetes complicates daily life. Therefore, it is important to design strategies to help patients and their families better manage the disease, ensuring they receive the required psychological support for optimal disease management.

Glycemic Outcomes Persist for up to 2 Years in Very Young Children with the Omnipod® 5 Automated Insulin Delivery System.

Background: To evaluate the long-term safety and effectiveness of the Omnipod® 5 Automated Insulin Delivery (AID) System in very young children with type 1 diabetes with up to 2 years of use. Methods: Following a 13-week single-arm, multicenter, pivotal trial that took place after 14 days of standard therapy data collection, participating children (2-5.9 years of age at study enrollment) were provided the option to continue use of the AID system in an extension phase. HbA1c was measured every 3 months, up to 15 months of total use, and continuous glucose monitor metrics were collected through the completion of the extension study (for up to 2 years). Results: Participants (N = 80) completed 18.2 [17.4, 23.4] (median [interquartile range]) total months of AID, inclusive of the 3-month pivotal trial. During the pivotal trial, HbA1c decreased from 7.4% ± 1.0% (57 ± 10.9 mmol/mol) to 6.9% ± 0.7% (52 ± 7.7 mmol/mol, P < 0.0001) and was maintained at 7.0% ± 0.7% (53 ± 7.7 mmol/mol) after 15 months total use (P < 0.0001 from baseline). Time in target range (70-180 mg/dL) increased from 57.2% ± 15.3% during standard therapy to 68.1% ± 9.0% during the pivotal trial (P < 0.0001) and was maintained at 67.2% ± 9.3% during the extension phase (P < 0.0001 from standard therapy). Participants spent a median 97.1% of time in Automated Mode during the extension phase, with one episode of severe hypoglycemia and one episode of diabetic ketoacidosis. Conclusion: This evaluation of the Omnipod 5 AID System indicates that long-term use can safely maintain improvements in glycemic outcomes with up to 2 years of use in very young children with type 1 diabetes. Clinical Trials Registration Number: NCT04476472.

A possible case of glycogenic hepatopathy in a schoolboy with poorly controlled type 1 diabetes mellitus

Glycogenic hepatopathy (GH) is a rare condition that can occur in individuals with poorly controlled diabetes mellitus, particularly in those with type 1 diabetes mellitus(T1DM). This condition is characterised by hepatomegaly and elevated liver enzymes. GH is associated with the accumulation of glycogen in the liver, which is a result of uncontrolled hyperglycemia and excessive glycogen storage in liver cells. We present a case of a 15-year-old boy who has been diagnosed with T1DM at the age of 8 and has experienced recurrent episodes of diabetic ketoacidosis (DKA). In this specific instance, he was admitted for treatment of DKA and was also diagnosed with GH.

Phenotype and predictors of insulin independence in adults presenting with diabetic ketoacidosis: a prospective cohort study

Aims/hypothesisThe aim of this work was to describe the phenotype of adults presenting with a first episode of diabetic ketoacidosis (DKA) in Cape Town, South Africa, and identify predictors of insulin independence at 12 and 60 months after presentation.MethodsA prospective, descriptive cohort study of all individuals, 18 years or older, presenting for the first time with DKA to four public-sector hospitals of the Groote Schuur Academic Health Complex was performed. Clinical, biochemical and laboratory data including GAD antibody and C-peptide status were collected at baseline. Insulin was systematically weaned and stopped in individuals who achieved normoglycaemia within the months after DKA. Individuals were followed for 12 months and then annually until 5 years after initial presentation with ketoacidosis.ResultsEighty-eight individuals newly diagnosed with diabetes when presenting with DKA were included and followed for 5 years. The mean ± SD age was 35±10 years and the median (IQR) BMI at diagnosis was 28.5 (23.3–33.4) kg/m2. Overall, 46% were insulin independent 12 months after diagnosis and 26% remained insulin independent 5 years after presentation. Forty-one participants (47%) tested negative for anti-GAD and anti-IA-2 antibodies and had C-peptide levels >0.3 nmol/l; in this group, 68% were insulin independent at 12 months and 37% at 5 years after diagnosis. The presence of acanthosis nigricans was strongly associated with insulin independence (OR 27.1 [95% CI 7.2, 102.2]; p<0.001); a positive antibody status was associated with a lower likelihood of insulin independence at 12 months (OR 0.10 [95% CI 0.03, 0.36]; p<0.001). On multivariable analysis only acanthosis (OR 11.5 [95% CI 2.5, 53.2]; p=0.004) was predictive of insulin independence 5 years after diagnosis.Conclusions/interpretationThe predominant phenotype of adults presenting with a first episode of DKA in Cape Town, South Africa, was that of ketosis-prone type 2 diabetes. These individuals presented with obesity, acanthosis nigricans, negative antibodies and normal C-peptide and could potentially be weaned off insulin at follow-up. Classic type 1 diabetes (lower weight, antibody positivity, low or unrecordable C-peptide levels and long-term insulin dependence) was less common. The simple clinical sign of acanthosis nigricans is a strong predictor of insulin independence at 12 months and 5 years after initial presentation.Graphical

Social and Metabolic Characteristics Associated With Multiple DKA Admissions at a Large County Hospital.

Diabetic ketoacidosis (DKA) is a preventable, deadly, and costly complication of type 1 diabetes mellitus (T1DM). Some individuals with T1DM have recurrent DKA admissions. We sought to characterize social factors that differ between patients with single vs multiple DKA admissions at an urban, safety-net hospital. We queried the electronic health records for T1DM patients admitted for DKA from 2019 to 2021. Admission laboratory values, demographic information, and detailed social histories were collected and analyzed statistically, including logistical regression. A total of 243 patients were admitted for DKA, 64 of whom had multiple DKA admissions. There was no significant difference between the groups in their admission laboratory values, hospital length of stay, health-care payer status, history of homelessness, current employment, living alone, independence of activities of daily living, and barriers to discharge. T1DM patients with multiple DKA admissions had greater rates of substance use disorder (33.0% vs 60.9%; P < .001), especially with cannabis (6.7% vs 25.0%; P < .001), tobacco (26.3% vs 46.3%; P = .002), and psychoactive substance use (1.1% vs 6.3%; P = .043). Regression models of substance use showed increased risk with any substance use (odds ratio [CI] 3.17 [1.78-5.73]; P < .001) and cannabis (3.70 [1.55-8.83]; P = .003). We identified substance use as a possible predictor of T1DM patients at risk for multiple DKA admissions. Our findings identify a group of T1DM patients for whom interventions may help to decrease recurrence of DKA episodes within similar community hospital populations.

Prevalence and associations of impaired awareness of hypoglycemia in a pediatric type 1 diabetes population – The Norwegian Childhood Diabetes Registry

AimsTo determine the prevalence and associations of impaired awareness of hypoglycemia (IAH) in pediatric type 1 diabetes. MethodsNationwide, population-based cross-sectional study with 51 % participation. Participants (n = 1329; 53 % males) aged 2–19 years (median 13.3) with type 1 diabetes ≥ 6 months (median 4.6 years) self-assessed hypoglycemia awareness with a validated questionnaire (‘Clarke’). Parents responded for children aged < 9 years (n = 235). We estimated associations between IAH and clinical data in the Norwegian Childhood Diabetes Registry. ResultsThe overall prevalence of IAH was 22 %, but gradually decreased from 53 % in preschoolers to 12 % in adolescents aged ≥ 16 years. IAH was associated (adjusted OR; 95 %CI) with episodes of severe hypoglycemia (6.0; 3.04, 11.8) and diabetic ketoacidosis (3.45; 1.37, 8.68) the preceding year, increased fear of hypoglycemia (highest quartile vs. lowest: 2.27; 1.51, 3.40), female sex (1.41; 1.05, 1.90), and HbA1c ≥ 8.5 % (69 mmol/mol) vs. 7.5–8.4 % (58–68 mmol/mol) (1.48; 1.01, 2.18), but not with disease duration, use of insulin pump or continuous glucose monitoring, or HbA1c < 7.5 % (58 mmol/mol). ConclusionsIAH is prevalent in pediatric diabetes and more likely reported in young children. IAH is associated with severe hypoglycemia and fear of hypoglycemia, but good metabolic control seems achievable without increased risk of IAH.

Outcome of adults with diabetic ketoacidosis admitted to intensive care unit: a retrospective study.

Background: Numerous advancements in diabetes care have been made over the past 20 years. Few studies discussed the outcome and predictors of diabetic ketoacidosis (DKA) necessitating admission to intensive care units (ICU). We, therefore, performed a retrospective analysis of DKA patients admitted to King Saud Medical City\&amp;apos;s ICU between August 2022 and August 2023 to examine trends in outcome and predictors. Method: Patients with DKA episodes who visited the emergency room at King Saud Medical City in Riyadh, Saudi Arabia, between August 2022 and August 2023 were included in this retrospective analysis. Every adult patient, who met the American Diabetes Association\&amp;apos;s requirements for DKA diagnosis and was at least 18 years old, was included. Results In the final analysis, we included 218 patients with DKA, of whom 56 (25.6) were under ICU care. The patients admitted to the ICU had higher BMI and were more likely to be male than non-ICU patients, they were also having advanced age. DKA patients with type 2 diabetes mellitus (T2DM) had a higher likelihood of ICU admission than those with T1D. In patients with DKA needed ICU care, WBC counts were higher, as were urea level, and CRP. Compared to patients who did not need ICU admission, those who needed to be admitted had lower venous pH level and bicarbonate levels. Furthermore, 3.5% of ICU-admitted patients died in hospital, compared to 0 deaths among non-ICU admitted patients. Conclusion: Of all patients with DKA, 25.6% needed ICU. Some factors that indicate a patient\&amp;apos;s likelihood of needing an ICU were; T2DM, advanced age, an infectious cause, newly diagnosed diabetes, and moderate or severe DKA.

Clinical and Biochemical Characteristics of Pediatric Diabetic Ketoacidosis Admissions to COVID-19 Free UAE Tertiary Center during Pandemic

Background: COVID-19 pandemic led to delayed diagnosis and increase in number and severity of type 1 diabetes mellitus (T1DM) and diabetic ketoacidosis (DKA) cases in pediatric population worldwide. The indirect impact of the pandemic on pediatric DKA admissions to COVID-19-free hospitals worth to be evaluated. Objectives: Our aim was to evaluate the characteristics and severity of DKA admissions before and during the pandemic to COVID-19-free hospital. Methods: This descriptive retrospective study included 130 episodes of DKA for patients aged below 16 years admitted to Tawam Hospital, a COVID-19-free hospital, between March 2017 and Feb 2021. Data from March 2020 to Feb 2021 (pandemic) were compared to the previous 3 years, March 2017 to Feb 2020 (pre-pandemic). Data were retrieved from the electronic records and analyzed using STATA13. Results: We evaluated 130 DKA admissions (63 pandemic and 67 pre-pandemic). The majority of patients in the pandemic group were in, the age group of (6–11.9 years) (54% vs. 23.9%, p = 0.001), and higher proportion of them was diagnosed with new-onset diabetes (42.9% vs. 25.4%, p = 0.035). Overall, there was no significant difference in symptoms duration, DKA severity, or time to DKA resolution, but there was a difference in the median (IQR) HbA1C, 11% (9.4–12.95) vs. 10.15% (9.27–11.80) (p = 0.0297) in the pandemic and pre-pandemic groups, respectively. Conclusion: In our COVID-19-free hospital, the pandemic and service reallocation has led to an increased rate of DKA admissions with increased number of newly diagnosed T1DM. Clinical presentation and severity were not adversely affected.

Pregnancy and diabetic ketoacidosis: fetal jeopardy and windows of opportunity.

Diabetic ketoacidosis (DKA) during pregnancy poses significant risks to both the mother and fetus, with an increased risk of fetal demise. Although more prevalent in women with Type I diabetes (T1D); those with Type 2 diabetes (T2D) and gestational diabetes mellitus (GDM) can also develop DKA. A lack of information about DKA during pregnancy exists worldwide, including in South Africa. This study examined the characteristics and outcomes associated with DKA during pregnancy. The study took place between 1 April 2020 and 1 October 2022. Pregnant women with DKA, admitted to Tygerberg Hospital's Obstetric Critical Care Unit (OCCU) were included. Maternal characteristics, precipitants of DKA, adverse events during treatment, and maternal-fetal outcomes were examined. There were 54 episodes of DKA among 47 women. Most DKA's were mild and occurred in the third trimester. Pregestational diabetes dominated (31/47; 60%), with 47% having T1D and 94% requiring insulin. Seven women (7/47, 15%; T2D:6, T1D:1) had two episodes of DKA during the same pregnancy. Most women (32/47; 68%) were either overweight or obese. Yet, despite the T2D phenotype, biomarkers indicated that auto-immune diabetes was prevalent among women without any prior history of T1D (6/21; 29%). Twelve women (26%) developed gestational hypertension during pregnancy, and 17 (36%) pre-eclampsia. Precipitating causes of DKA included infection (14/54; 26%), insulin disruption (14/54; 26%) and betamethasone administration (10/54; 19%). More than half of the episodes of DKA involved hypokalemia (35/54, 65%) that was associated with fetal death (P=0.042) and hypoglycemia (28/54, 52%). Preterm birth (<37 weeks' gestation) occurred in 85% of women. No maternal deaths were recorded. A high fetal mortality rate (13/47; 28%) that included 11 spontaneous intrauterine deaths and two medical terminations, was observed. Women with DKA have a high risk of fetal mortality as well as undiagnosed auto-immune diabetes. There is a strong link between maternal hypokalemia and fetal loss, suggesting an opportunity to address management gaps in pregnant women with DKA.

Using stories to explore the lived experience of alcohol consumption in people with diabetes mellitus

Abstract Background: Evidence supports the risks of dangerous episodes of hypoglycaemia, hyperglycaemia, or extreme glucose variability in type 1 diabetes during and after alcohol consumption. Minimal evidence regarding preventative self‐care strategies exists, and people with type 1 diabetes can develop personal tactics to overcome risks. Combining the lived experience of managing alcohol consumption while living with diabetes will enrich new patient and health care professional education.Methods: Participants were recruited from social media, and attended between one and three online storytelling workshops. Demographic data were collected by questionnaire, and qualitative data were collected by note‐taking during the online sessions and evaluated by thematic analysis.Results: Nine participants aged 18–36 years (type 1 diabetes = seven [three female], and type 2 diabetes = two [both male]) were recruited. Insulin administration was by multiple daily injection therapy (n=5 including one type 2 diabetes), continuous subcutaneous insulin infusion (n=3) without hybrid closed loop, and sulphonylurea plus morning long‐acting analogue insulin (n=1 type 2 diabetes). From the nine participant stories three diabetic ketoacidosis, three hypoglycaemia, and one extreme glucose variability episodes occurred. Four clustered themes were found: living with diabetes, managing alcohol, app development suggestions, and future development suggestions.Discussion: New insights discovered were: distressing glucose risks including diabetic ketoacidosis episodes, misinterpretation of glucose and intoxication symptoms, trial and error approaches, and non‐disclosure to health care professionals regarding severe glucose situations. Copyright © 2023 John Wiley &amp; Sons.

Safety and glycemic outcomes during the MiniMed™ advanced hybrid closed-loop (AHCL) system pivotal trial in children and adolescents with type 1 diabetes.

During MiniMed™ advanced hybrid closed-loop (AHCL) use by adolescents and adults in the pivotal trial, A1C was significantly reduced, time in range (TIR) was significantly increased, and there were no episodes of severe hypoglycemia or diabetic ketoacidosis (DKA). The present study investigated the same primary safety and effectiveness endpoints during AHCL use by a younger cohort with T1D. An intention to treat population (N=160, aged 7-17 years) with T1D was enrolled in a single-arm study at 13 investigational centers. There was a baseline run-in (~25 days) using HCL or sensor-augmented pump with/without predictive low glucose management, followed by a three-month study period with AHCL activated at two glucose targets (100mg/dL and 120mg/dL) for ~45 days each. The mean±SD of A1C, TIR, mean sensor glucose (SG), coefficient of variation (CV) of SG, time at SG ranges, and insulin delivered between baseline or run-in and study were analyzed (Wilcoxon signed-rank test or t-test). Compared to baseline, AHCL use was associated with reduced A1C from 7.9±0.9% (N=160) to 7.4±0.7% (N=136) (p<0.001) and overall TIR increased from the run-in 59.4±11.8% to 70.3±6.5% by end of study (p<0.001), without change in CV, TBR <70mg/dL or TBR <54mg/dL. Relative to longer active insulin time (AIT) settings (N=52), an AIT of 2 hours (N=10) with the 100mg/dL glucose target (GT) increased mean TIR to 73.4%, reduced TBR <70mg/dL from 3.5% to 2.2% and reduced TAR >180mg/dL from 28.7% to 24.4%. During AHCL use, there was no severe hypoglycemia or DKA. In children and adolescents with T1D, MiniMed™ AHCL system use was safe, A1C was lower, and TIR was increased. The lowest GT and shortest AIT was associated with the highest TIR and lowest TBR and TAR, all of which met recommended glycemic targets.