Outcome Of Diabetic Ketoacidosis Research Articles

Prevalence, Clinical Profile, and Outcomes of Diabetic Ketoacidosis in Pediatric Patients at the Intensive Care Unit of King Fahad Hospital, Al-Baha, Saudi Arabia

Prevalence, Clinical Profile, and Outcomes of Diabetic Ketoacidosis in Pediatric Patients at the Intensive Care Unit of King Fahad Hospital, Al-Baha, Saudi Arabia

Comparative study of diabetic ketoacidosis in the elderly and non-elderly patients: A nine-year experience from an academic hospital in North India

Background and aimsDespite an increasing prevalence of the aged population with diabetes in low-middle-income countries, there is limited literature on geriatric hyperglycemic emergencies. The present study aimed to compare the spectrum and outcomes of diabetic ketoacidosis (DKA) between elderly and non-elderly adult patients in India. MethodsSeventy-seven elderly patients (≥60 years) were compared to 477 non-elderly patients (13–59 years) with DKA admitted to the medical emergency, Postgraduate Institute of Medical Education and Research, Chandigarh, India, between January 2014 and December 2022. Clinical features, laboratory parameters, precipitating factors, and in-hospital outcomes were reviewed. ResultsElderly patients less commonly had vomiting and abdominal pain than non-elderly patients (31.3 % vs. 66.2 %, 27.3 % vs. 60.1 %, respectively) and typically presented with dyspnea (48.5 %), altered mental status (47.8 %), and fever (46.3 %). Ketonemia and metabolic acidosis were significantly more marked in non-elderly patients, whereas elderly patients frequently had anemia, hypoalbuminemia, and renal dysfunction. The most common precipitations of geriatric DKA were infections (70.1 %), followed by treatment non-adherence (66.2 %) and non-infectious disorders (35.1 %). Infections and non-infectious disorders were significantly more frequent in elderly patients than in non-elderly patients. Respiratory and urinary tract infections were prevalent in both age groups.In-hospital survival was 74.9 % (n = 415) and remained lower in older patients (48.1 % vs. 79.2 %, P-value <0.001). The independent prognostic factors were age (OR 1.030, 95 % CI 1.006–1.054, P = 0.014), Glasgow coma scale (OR 0.789, 95 % CI 0.717–0.869, P <0.001), and infection trigger (OR 6.635, 95 % CI 2.852–15.441, P <0.001). ConclusionOlder patients with DKA present atypically, frequently have precipitation with infections and noninfectious disorders, and have poor outcomes.

Precipitating Factors and Outcome of Diabetic Ketoacidosis among Children and Adolescents with Type-1 Diabetes Mellitus.

To determine the precipitating factors and outcomes of diabetic ketoacidosis (DKA) among patients with type 1 diabetes mellitus. An analytical study. Place and Duration of the Study: Department of Paediatrics, National Institute of Child Health, Karachi, Pakistan, from July to December 2022. Children of either gender aged up to 18 years and presenting with DKA with a known diagnosis of type-1 diabetes were enrolled. Demographic, clinical, and anthropometric characteristics of all children were noted. Laboratory investigations were sent to the institutional laboratory. Presenting features, precipitating factors, severity of DKA, and outcomes noted. Among 131 children, 101 (77.1%) were girls. The socio-economic status of 75 (57.3%) patients was the lower middle. Celiac disease was the commonest associated disease noted in 23 (17.6%) patients. A total of 123 (93.9%) children were using basal plus bolus types. Adherence to diabetes-related drug therapy was seen in 105 (80.2%) patients. At the time of presentation, vomiting, fever, abdominal pain, and respiratory distress were the most frequent presenting features reported in 77 (58.8%), 67 (51.1%), 42 (32.1%), and 34 (26.0%) patients, respectively. The most common precipitating factors for DKA were infection/illness (n=90, 68.7%) and missed insulin dose (n=16, 12.2%); no cause was identified in 25 (19.1%) patients. The mean duration of hospital stay was 5.25±2.4 days. Four patients could not survive. The most common precipitating factor for the current episode of DKA were infection or illness, or missed insulin dose. Vomiting, fever, abdominal pain, and respiratory distress were the most frequent presenting features. In-hospital mortality was found to be 3% in DKA patients. Diabetic ketoacidosis, Type-1 diabetes mellitus, Insulin, Vomiting, Abdominal pain.

1363-P: Clinical Profile and Outcome of Diabetic Ketoacidosis in an Emergency Department Non-COVID ICU

The clinical profile of DKA in a 4-bedded ED ICU of a single tertiary care centre from 12 April 2022 to 4 January 2023 is presented. A total of 11 DKA events were managed, with a mean age of 45.5 ± 19.2 y with M: F ratio of 1:2.7. Type 1 in 36%, type 2 in 45% and 18% were unclassified. 55% had no comorbidities, and 45% had Hypertension, CAD, CKD, and hypothyroidism. Presented with nausea &amp; vomiting in 6 (55 %), shortness of breath in 5 (45%), dysuria in 4 (36 %), fever &amp; fatiguability in 3 (27%), abdominal pain, chest pain, loose stools in 2 (18%), cough, haematemesis and loss of consciousness in 1 (9%). Of the total patients, 36 % were only on OADs, 18 % on Insulin and OADs and 18 % on Insulin alone. Duration of diabetes ranged from 2 to 13 years, and 2 were first diagnosed. Reasons for DKA were Non-adherence to medication (18%), the first presentation of DM (18%), Infections (73%), CAD-ACS (18%) and Pancreatitis (9%). One patient was on Dapagliflozin 10 mg daily with blood glucose 240 mg/dL at presentation. Lab parameters are shown in Table 1. Course in ICU: All patients received the standard treatment of DKA. 27 % had AKI and 27% had Acute on CKD. ICU mortality was 36 % with definite alternative causes identified for death. Conclusions: Infections are the most important cause of precipitating events for DKA. Co-morbidities and Complications decide the outcome and early recognition and standard treatment and ICU care are important in critically ill. Disclosure C.R: None. B.N.Jami: None. A.Suresh: None. A.J.Mangaly: None.

Incidence, characteristics, risk factors and outcomes of diabetic ketoacidosis in COVID-19 patients: Comparison with influenza and pre-pandemic data.

This study characterized incidence, patient profiles, risk factors and outcomes of in-hospital diabetic ketoacidosis (DKA) in patients with COVID-19 compared with influenza and pre-pandemic data. This study consisted of 13 383 hospitalized patients with COVID-19 (March 2020-July 2022), 19 165 hospitalized patients with influenza (January 2018-July 2022) and 35 000 randomly sampled hospitalized pre-pandemic patients (January 2017-December 2019) in Montefiore Health System, Bronx, NY, USA. Primary outcomes were incidence of in-hospital DKA, in-hospital mortality, and insulin use at 3 and 6 months post-infection. Risk factors for developing DKA were identified. The overall incidence of DKA in patients with COVID-19 and influenza, and pre-pandemic were 2.1%, 1.4% and 0.5%, respectively (p < .05 pairwise). Patients with COVID-19 with DKA had worse acute outcomes (p < .05) and higher incidence of new insulin treatment 3 and 6 months post-infection compared with patients with influenza with DKA (p < .05). The incidence of DKA in patients with COVID-19 was highest among patients with type 1 diabetes (12.8%), followed by patients with insulin-dependent type 2 diabetes (T2D; 5.2%), non-insulin dependent T2D (2.3%) and, lastly, patients without T2D (1.3%). Patients with COVID-19 with DKA had worse disease severity and higher mortality [odds ratio = 6.178 (4.428-8.590), p < .0001] compared with those without DKA. Type 1 diabetes, steroid therapy for COVID-19, COVID-19 status, black race and male gender were associated with increased risk of DKA. The incidence of DKA was higher in COVID-19 cohort compared to the influenza and pre-pandemic cohort. Patients with COVID-19 with DKA had worse outcomes compared with those without. Many COVID-19 survivors who developed DKA during hospitalization became insulin dependent. Identification of risk factors for DKA and new insulin-dependency could enable careful monitoring and timely intervention.

Clinical Characteristics and Outcomes of Diabetic Ketoacidosis in Patients With Type 2 Diabetes using SGLT2 Inhibitors.

Sodium glucose cotransporter 2 inhibitors (SGLT2i) use is associated with an increased risk of diabetic ketoacidosis (DKA). This study evaluated and compared the DKA characteristics and outcomes of users and non-users of SGLT2i. We retrospectively studied patients with type 2 diabetes mellitus (T2DM) admitted with DKA to Tawam Hospital, Al Ain City, UAE between January 2017 and March 2021. Demographic data, clinical, and laboratory findings were extracted from the electronic medical records. A total of 55 patients with T2DM (62% UAE nationals, 50% women) were admitted with DKA. The average age was 54.0 ± 18.9 years and average diabetes duration of 15.7 ± 15.1 years. Seventeen patients (31%) were using SGLT2i. Infection was the main precipitating factor for DKA in (8 out of 17) SGLT2i users. Compared to non-users, SGLT2i users had lower systolic blood pressure (119.9 vs 140 mmHg; P = .012) and serum glucose levels (16.2 vs 24.9 mmol/L; P < .001) and higher Na level (137.5 vs 132.6 mmol/L; P = .005). Additionally, 56.3% of SGLT2i users had euglycemic DKA compared to 2.6% of nonusers (P < .001). Acute kidney injury (AKI) occurred more in SGLT2i users compared to non-users (94.1% vs 67.6%, P = .043). Further analysis revealed that SGLT2i users were about five times more likely to have prolonged hospital length of stay (⩾14 days) when compared with non-users (adjusted OR: 4.84; P = .035). Overall, there was no difference between the two groups with regards to DKA complications and mortality. SGLT2i related DKA is associated with lower blood glucose levels, lower SBP, worse hypovolemia, increased risk of AKI, and longer hospital stay when compared to non SGLT2i related episodes. Since the benefits of SGLT2 inhibitors far outweigh potential risks, there is a need to raise healthcare professionals and patients' awareness about this potential association.

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.

Abstract #1174261: Effect of Hospital Teaching Status on Outcomes of Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is one of the hyperglycemic complications of both type 1 and types 2 diabetes. Management requires inpatient admission and sometimes even intensive unit level of care depending on the severity presentation. Patients with DKA can either be managed in teaching or non-teaching hospital. We sought to investigate the effect of hospital teaching status on the outcome of patients admitted for DKA.

Diabetic Ketoacidosis at the Onset of Type 1 Diabetes Mellitus Among Children and Adolescents in Jeddah, Saudi Arabia: A Study From the Emergency Department

Background: Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM) and a leading cause of morbidity and mortality in children. We aim to assess the frequency, clinical characteristics, biochemical findings, and outcomes of DKA at the onset of T1DM in young children and adolescents.Design and methods: This retrospective cohort study analyzed the medical records of patients ≤ 16 years old seen in the emergency department at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between April 2015 and June 2019. The severity of DKA was classified according to the International Society for Pediatric and Adolescent Diabetes (ISPAD) criteria.Results: Out of 207 patients with T1DM, 53 presented with DKA as a new onset. The mean age was 8.51 ± 3.81 years, with the majority being 5-10 years old (52.8%). Polyuria (98.1%), polydipsia (86.8%), weight loss (62.3%), and abdominal pain and vomiting (45.3%) were the most frequent symptoms. Mean random blood glucose was 424.09 ± 108.67 mg/dL and mean venous pH was 7.15 ± 0.36 mmol/L. Of patients, 66% had no associated complications, 24.4% had hypokalemia, 20.8% developed hypoglycemia, and 18.9% developed hyperchloremic metabolic acidosis. One patient had cerebral edema and coma. Based on metabolic acidosis, 24.5% had mild DKA, an equal percentage had severe DKA, and 9.4% had moderate DKA. Of patients, 88.7% were admitted to the pediatric ward and 15.1% to the intensive care unit.Conclusion: A total of 25% of patients diagnosed with T1DM below the age of 17 years presented with DKA. No permanent disabilities or deaths were reported. Forming a registry dedicated to T1DM is needed to follow up on these patients, especially among school-age children, as well as aid in the development of future research locally.

Clinical Profile and Outcomes of Diabetic Ketoacidosis during the COVID-19 Pandemic in North India.

Although recent data have shown a declining trend in mortality in diabetic ketoacidosis (DKA), the outcomes are likely to be different during the coronavirus (COVID-19) pandemic. We conducted a prospective cohort study to evaluate the spectrum and outcomes of adult DKA during the pandemic and document differences in DKA patients with or without COVID-19. A total of 169 patients (mean age 44 years) were admitted at the Emergency Department of PGIMER, Chandigarh (India), from January 2020 to June 2021. The precipitating factors were noncompliance with antidiabetic therapy (77.5%), infections (62.7%), and noninfectious conditions (21.3%). Thirty-nine (23.1%) patients had COVID-19, including 31 with severe infection. DKA severity and resolution, ventilator requirement, hospital stay, and mortality were similar in the patients with or without COVID-19. In-hospital mortality was 39.6% (n = 67). The independent mortality predictors were ventilator requirement (p-0.000), an infection trigger (p-0.049), and hyperosmolarity (p-0.048). DKA mortality is increased significantly during the 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.

How does the difference in severity at presentation affect the management and outcomes of diabetic ketoacidosis in people with type 1 and type 2 diabetes?

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

Impact of ethnicity on presentation, management and outcome of diabetic ketoacidosis in type 1 and type 2 diabetes mellitus

Impact of ethnicity on presentation, management and outcome of diabetic ketoacidosis in type 1 and type 2 diabetes mellitus

How does age and sex impact on presentation, clinical course and outcome of diabetic ketoacidosis in type 1 and type 2 diabetes?

How does age and sex impact on presentation, clinical course and outcome of diabetic ketoacidosis in type 1 and type 2 diabetes?

Outcomes of diabetic ketoacidosis in a tertiary centre with restricted intensive care unit bed capacity.

Diabetic ketoacidosis (DKA) is an acute metabolic condition, sometimes requiring admission to an intensive care unit (ICU). To investigate the outcomes of DKA patients admitted to a hospital with restricted ICU capacity. We included all DKA patients above age 18 who were admitted to a tertiary hospital during 2004-2017. We conducted multivariate logistic regression analysis adjusted for ICU bed availability to analyse parameters associated with ICU admission, and a composite outcome of mortality, DKA recurrence and mechanical ventilation. Among 382 DKA patients in our cohort, 94 (24.6%) were admitted to the ICU. The in-hospital mortality was 4.7%. Low bicarbonate (<10 mmoL/L) and pH (<7) levels at presentation were associated with ICU admission (P < 0.001 for both). In multivariate models availability of beds in the ICU was not associated with ICU admission, mortality or DKA recurrence of any type. In a setting of limited ICU capacity, DKA treatment does not necessarily require admission to the ICU. When the rising rates of diabetes mellitus and the associated elevated rates of DKA are taken into account, our results highlight the importance of including step-down units when devising local protocols for care of these patients.

English

English

Characteristics and Outcomes of Children with Type-I Diabetes Mellitus Hospitalized for Ketoacidosis.

Type 1 diabetes mellitus is a common autoimmune disorder that often presents in children. In these patients, diabetic ketoacidosis is one of the most common and serious acute complications associated with significant morbidity and mortality. Nevertheless, limited studies are conducted in Ethiopia. The aim of this study was to assess patient-related characteristics and outcomes of diabetic ketoacidosis, and their relative difference among children with newly diagnosed and previously known type-I diabetes mellitus. This is a retrospective cross-sectional study of 63 type-1 diabetes patients admitted for ketoacidosis at Jimma university medical center, a tertiary hospital. Data was collected using a checklist, and entered into Epidata 4.2.0.0 and analyzed using STATA 13.0. Descriptive statistics was performed; Mann-Whitney and Chi-square test statistics were employed for comparison. Of the total, 39 were newly diagnosed type-I diabetes patients. Polydipsia and Polyuria (each in 74.6%) were the predominant symptoms at presentation. ketoacidosis precipitants were undocumented in the majority of the patients (53.97%). Mean (±SD) Random blood sugar was 434.05 (±117.62)mg/dl. Ketoacidosis was mild in severity in 63.49%. Family history of diabetes, unknown precipitants and the first episode of ketoacidosis were significantly different among the new and known type-I diabetes patients. No mortality was documented. The observed patient characteristics are typical of those reported in many studies and standard resources. Despite no mortality was documented, the need for early diagnosis and management should not be overlooked. Further study, with large sample size, is recommended to point-out the real characteristics difference among new and known type-I diabetes mellitus patients admitted for ketoacidosis.

Utility of Computerized Tomography Scan of Head in Treatment Decisions for Suspected Cerebral Edema in Children with Diabetic Ketoacidosis

Background Diabetic ketoacidosis (DKA) is a life-threatening complication in children with type 1 diabetes mellitus (T1DM). The development of cerebral edema (CE) remains one of the most feared outcomes of DKA. Although CE is rare, it has a mortality rate reaching 25%. The onset of CE may present with symptoms such as severe headache, a sudden change in mental status, or decorticate posturing. Current guidelines regarding the management of CE focus on emergent stabilization through mannitol or hypertonic saline administration combined with fluid restriction, with consideration of imaging, primarily head computed tomography (HCT), after prompt treatment initiation. …

1537-P: Impact of Obesity on Outcomes of Diabetic Ketoacidosis: A Nationwide Analysis

Background: Obesity is associated with better outcomes in diseases like myocardial infarction and heart failure, a phenomenon known as obesity paradox. However, the effect of obesity on healthcare outcomes after admission for diabetic ketoacidosis (DKA) has not been well characterized. Objective: We aimed to explore the impact of obesity and morbid obesity on outcomes in patients hospitalized with DKA. Methods: The National Inpatient Sample database for the year 2016 was queried. All admissions with a principal diagnosis of DKA were identified. Obesity (BMI 30-40 kg/m2) and morbid obesity (BMI &amp;gt;40 Kg/m2) were identified using their appropriate validated ICD-10 codes. Statistical analysis was performed using STATA. The Odds ratio adjusted for age and gender was calculated for obesity and morbid obesity respectively. Results: The study included 210,455 hospitalizations with a principal diagnosis of DKA. Out of these, 19,341 (9.19%) were obese and 7,640 (3.63%) were morbidly obese. Obese DKA patients had a longer length of stay (3.79 vs. 3.14 days, p&amp;lt;0.001) and higher hospitalization costs ($34,643 vs. $28,976; p&amp;lt;0.001) compared to their non-obese counterparts. There was no significant difference in the adjusted in-hospital mortality rates in DKA patients with and without obesity (0.52% vs. 0.38%, adjusted odds ratio 1.25, p=0.34). However, DKA patients who were morbidly obese had increased mortality compared to those without morbid obesity (0.72% vs. 0.38%, adjusted odds ratio 1.85, p=0.04). Conclusion: DKA patients with obesity have a longer length of stay and higher hospitalization costs, but similar inpatient mortality rates compared to those without obesity. Morbid obesity is associated with increased mortality in DKA patients. Disclosure M. Mudgal: None. A. Goel: None.