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Kumar A, Doola R, Zahumensky A, Shaikh A, Tabah A, Laupland KB, Ramanan M. Association between elevated lactate and clinical outcomes in adults with diabetic ketoacidosis. J Crit Care 2023; 78:154377. [PMID: 37478533 DOI: 10.1016/j.jcrc.2023.154377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE To assess the occurrence of hyperlactatemia among patients admitted to the intensive care unit (ICU) with diabetic ketoacidosis (DKA), and effect on in-hospital mortality. MATERIALS AND METHODS A retrospective, multicentre, cohort study of adult patients admitted to ICU with a primary diagnosis of DKA in Australia and New Zealand, utilising a pre-existing dataset. The primary exposure variable was lactate, dichotomised into normolactatemia (lactate <2.0 mmol/L) and hyperlactatemia (lactate ≥ 2.0 mmol/L) groups. The primary outcome was in-hospital mortality. Secondary outcomes included ICU and hospital length of stay (LOS), requirement for ventilation, renal replacement therapy (RRT) and inotropes. RESULTS The final dataset included 9061 patients. Hyperlactatemia was associated with in-hospital mortality (Odds Ratio [OR] 1.785 (95% CI 1.122-2.841, p = 0.014), hospital LOS (Geometric mean ratio [GMR] 1.063, 95% CI 1.025-1.103, p = 0.001), ICU LOS (GMR 1.057, 95% CI 1.026-1.09. p < 0.001), RRT (OR 2.198, 95% CI 1.449-3.334, p < 0.001) and inotropes (OR 1.578, 95% CI 1.311-1.899, p < 0.001). These associations persisted in Type 2 but not Type 1 diabetics. CONCLUSIONS Hyperlactatemia in patients admitted to ICU with DKA is associated with higher mortality, longer hospital and ICU LOS, and higher rates of mechanical ventilation, RRT and inotropes.
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Affiliation(s)
- Aashish Kumar
- Intensive Care Unit, Logan Hospital, Queensland, Brisbane, Australia
| | - Ra'eesa Doola
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Queensland, Brisbane, Australia; PA-Southside Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Amanda Zahumensky
- Intensive Care Unit, Caboolture Hospital, Queensland, Brisbane, Australia
| | - Arif Shaikh
- Intensive Care Unit, Caboolture Hospital, Queensland, Brisbane, Australia
| | - Alexis Tabah
- Intensive Care Unit, Redcliffe Hospital, Queensland, Brisbane, Australia
| | - Kevin B Laupland
- Intensive Care Unit, Royal Brisbane and Women's Hospital, Queensland, Brisbane, Australia; Queensland University of Technology (QUT), Brisbane, Australia
| | - Mahesh Ramanan
- Intensive Care Unit, Caboolture Hospital, Queensland, Brisbane, Australia; Intensive Care Unit, The Prince Charles Hospital, Queensland, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia; Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia.
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Ahmad R, Narwaria M, Singh A, Kumar S, Haque M. Detecting Diabetic Ketoacidosis with Infection: Combating a Life-Threatening Emergency with Practical Diagnostic Tools. Diagnostics (Basel) 2023; 13:2441. [PMID: 37510185 PMCID: PMC10378387 DOI: 10.3390/diagnostics13142441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND 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. METHODS 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". RESULTS 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.
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Affiliation(s)
- Rahnuma Ahmad
- Department of Physiology, Medical College for Women and Hospital, Dhaka 1230, Bangladesh
| | - Mahendra Narwaria
- Asian Bariatrics Plus Hospital, V Wing-Mondeal Business Park, S G Highways, Ahmedabad 380054, India
| | - Arya Singh
- Asian Bariatrics Plus Hospital, V Wing-Mondeal Business Park, S G Highways, Ahmedabad 380054, India
| | - Santosh Kumar
- Department of Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar 382422, India
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur 57000, Malaysia
- Department of Scientific Research Center (KSRC), Karnavati School of Dentistry, Karnavati University, Gandhinagar 382422, India
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Ishimaru N, Shimokawa T, Nakajima T, Kanzawa Y, Kinami S. Bacteremia in patients with diabetic ketoacidosis: a cross-sectional study. Hosp Pract (1995) 2023; 51:95-100. [PMID: 36883415 DOI: 10.1080/21548331.2023.2189369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVES To determine the incidence of bacteremia in patients with DKA. METHODS We conducted a cross-sectional study of patients aged 18 years and older with a principal diagnosis of DKA or hyperglycemic hyperosmotic syndrome (HHS) who presented to our community hospital between 2008 and 2020. Using medical records from initial visits, we retrospectively calculated the incidence of bacteremia. This was defined as the percentage of subjects with positive blood cultures except for those with contamination. RESULTS Among 114 patients with hyperglycemic emergency, two sets of blood cultures were collected in 45 of 83 patients with DKA (54%), and 22 of 31 patients with HHS (71%). The mean age of patients with DKA was 53.7 years (19.1) and 47% were male, while the mean age of patients with HHS was 71.9 years (14.9) and 65% were male. The incidences of bacteremia and blood culture positivity were not significantly different between patients with DKA and those with HHS (4.8% vs. 12.9%, P = 0.21 and 8.9% vs. 18.2%, P = 0.42, respectively). Urinary tract infection was the most common concomitant infection of bacteria, with E. coli as the main causative organism. CONCLUSION Blood cultures were collected in approximately half of the patients with DKA, despite a nonnegligible number of them testing positive in blood culture. Promoting awareness of the need for taking blood culture is imperative for the early detection and management of bacteremia in patients with DKA. CLINICAL TRIAL REGISTRATION UMIN trial ID - UMIN000044097; jRCT trial ID - jRCT1050220185.
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Affiliation(s)
- Naoto Ishimaru
- Department of General Internal Medicine, Akashi Medical Center, Akashi, Japan
| | - Toshio Shimokawa
- Clinical Study Support Centre, Wakayama Medical University, Wakayama, Japan
| | - Takahiro Nakajima
- Department of General Internal Medicine, Akashi Medical Center, Akashi, Japan
| | - Yohei Kanzawa
- Department of General Internal Medicine, Akashi Medical Center, Akashi, Japan
| | - Saori Kinami
- Department of General Internal Medicine, Akashi Medical Center, Akashi, Japan
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Huang B, Yang S, Ye S. Systemic Infection Predictive Value of Procalcitonin to Lactic Acid Ratio in Diabetes Ketoacidosis Patients. Diabetes Metab Syndr Obes 2022; 15:2127-2133. [PMID: 35911501 PMCID: PMC9325875 DOI: 10.2147/dmso.s371437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/19/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Early detection of bacterial infections associated with adequate antibiotic treatment is key to improving diabetic ketoacidosis (DKA) outcomes. Our study aimed to investigate the different sepsis markers (including procalcitonin to lactic acid ratio, PLR) to diagnose bacterial infection in patients with DKA within one hour after admission. METHODS A total of 165 patients diagnosed with DKA were enrolled between July 2014 and July 2018 and divided into an infection group (N =62) and a non-infection group (N=103) based on the positive aetiological tests such as blood culture, sputum culture, urine culture, or definite focus of pulmonary, soft tissue, kidney, etc. RESULTS Our findings suggest the following: 1) leucocytes (threshold above 10×109 /L) and PLR (threshold above 0.438) within one hour after admission can help to identify patients with infection in the context of DKA. 2) A subgroup analysis demonstrated that PLR also has a high diagnostic efficacy for infection in patients with DKA, regardless of the type of diabetes. CONCLUSION This study concludes that leucocyte count (threshold > 10×109/L) and PLR (threshold above 0.438) show a diagnostic value to help distinguish DKA patients with infection. By combining these two markers, the reduction of antibiotic misuse may be possible.
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Affiliation(s)
- Bin Huang
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
- Research Institution of Diabetes, University of Science and Technology of China, Hefei, People’s Republic of China
| | - Shengju Yang
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
| | - Shandong Ye
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
- Correspondence: Shandong Ye, Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China, Email
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New-onset type 1 diabetes complicated by diabetic ketoacidosis and severe sepsis requiring extracorporeal membrane oxygenation and kidney replacement therapy. J Diabetes Metab Disord 2021; 20:1075-1079. [PMID: 34178873 DOI: 10.1007/s40200-021-00736-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
Diabetic ketoacidosis (DKA) accounts for up to a third of all new presentations of Type 1 Diabetes Mellitus (T1DM) in children and adolescents. While most cases are relatively uncomplicated new onset presentations, if DKA is compounded with an additional underlying severe illness, such as appendicitis or severe infection, diagnostic delays may be experienced, and treatment response and outcomes may be compromised. We report an atypical case of new onset diabetes with severe DKA and underlying severe sepsis, which responded poorly to traditional therapy resulting in maximal intensive care management including mechanical ventilation, inotropes, extracorporeal membrane oxygenation (ECMO) for cardiorespiratory support, and kidney replacement therapy.
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Ing TS, Ganta K, Bhave G, Lew SQ, Agaba EI, Argyropoulos C, Tzamaloukas AH. The Corrected Serum Sodium Concentration in Hyperglycemic Crises: Computation and Clinical Applications. Front Med (Lausanne) 2020; 7:477. [PMID: 32984372 PMCID: PMC7479837 DOI: 10.3389/fmed.2020.00477] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/15/2020] [Indexed: 12/15/2022] Open
Abstract
In hyperglycemia, hypertonicity results from solute (glucose) gain and loss of water in excess of sodium plus potassium through osmotic diuresis. Patients with stage 5 chronic kidney disease (CKD) and hyperglycemia have minimal or no osmotic diuresis; patients with preserved renal function and diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS) have often large osmotic diuresis. Hypertonicity from glucose gain is reversed with normalization of serum glucose ([Glu]); hypertonicity due to osmotic diuresis requires infusion of hypotonic solutions. Prediction of the serum sodium after [Glu] normalization (the corrected [Na]) estimates the part of hypertonicity caused by osmotic diuresis. Theoretical methods calculating the corrected [Na] and clinical reports allowing its calculation were reviewed. Corrected [Na] was computed separately in reports of DKA, HHS and hyperglycemia in CKD stage 5. The theoretical prediction of [Na] increase by 1.6 mmol/L per 5.6 mmol/L decrease in [Glu] in most clinical settings, except in extreme hyperglycemia or profound hypervolemia, was supported by studies of hyperglycemia in CKD stage 5 treated only with insulin. Mean corrected [Na] was 139.0 mmol/L in 772 hyperglycemic episodes in CKD stage 5 patients. In patients with preserved renal function, mean corrected [Na] was within the eunatremic range (141.1 mmol/L) in 7,812 DKA cases, and in the range of severe hypernatremia (160.8 mmol/L) in 755 cases of HHS. However, in DKA corrected [Na] was in the hypernatremic range in several reports and rose during treatment with adverse neurological consequences in other reports. The corrected [Na], computed as [Na] increase by 1.6 mmol/L per 5.6 mmol/L decrease in [Glu], provides a reasonable estimate of the degree of hypertonicity due to losses of hypotonic fluids through osmotic diuresis at presentation of DKH or HHS and should guide the tonicity of replacement solutions. However, the corrected [Na] may change during treatment because of ongoing fluid losses and should be monitored during treatment.
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Affiliation(s)
- Todd S Ing
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Chicago, IL, United States
| | - Kavitha Ganta
- Medicine Service, Department of Medicine, Raymond G. Murphy Veterans Affairs Medical Center, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Gautam Bhave
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Susie Q Lew
- Department of Medicine, George Washington University School of Medicine, Washington, DC, United States
| | | | - Christos Argyropoulos
- Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Antonios H Tzamaloukas
- Research Service, Department of Medicine, Raymond G. Murphy Veterans Affairs Medical Center, University of New Mexico School of Medicine, Albuquerque, NM, United States
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Lee D, Lee R, Gowda NB, Probasco WV, Stake S, Ibrahim G, Pandarinath R. Impact of diabetes mellitus on surgical complications in patients undergoing revision total knee arthroplasty: Insulin dependence makes a difference. J Clin Orthop Trauma 2020; 11:140-146. [PMID: 32002003 PMCID: PMC6985014 DOI: 10.1016/j.jcot.2019.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 06/16/2019] [Accepted: 07/17/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Assessing the effects of diabetes mellitus (DM), non-insulin-dependent diabetes mellitus (NIDDM), and insulin-dependent diabetes mellitus (IDDM) on revision TKA (rTKA) has become increasingly imperative due to the increased rates of revisions associated with DM. This study sought to identify complications in rTKA that were independently associated with NIDDM/IDDM compared to non-diabetic (Non-DM) patients and whether IDDM was associated with specific postoperative complications compared to NIDDM. METHODS AND MATERIALS 16,428 rTKA patients were identified from the ACS-NSQIP database from 2005 to 2016 and stratified into three separate cohorts. 12,922 (78.66%) were Non-DM, 2335 (14.21%) had NIDDM, and 1171 (7.13%) had IDDM. Univariate analyses were utilized to assess for differences in demographics, preoperative comorbidities, and postoperative complication rates. Multivariate logistic regression analyses were then employed to control for significant differences in patients characteristics to assess NIDDM and IDDM as independent risk factors for complications in comparison to Non-DM. IDDM was further analyzed as a risk factor in comparison to NIDDM for the purpose of elucidating the impact of insulin dependence on risk for postoperative complications. RESULTS NIDDM was an independent risk factor for deep incisional surgical site infections (Odds Ratio (OR): 2.477) and urinary tract infections (UTI) (OR 1.862) (p < 0.05). Compared to NIDDM, IDDM was independently associated with greater risk for pneumonia (OR 2.603), septic shock (OR 6.597), blood transfusions (OR 1.326), and an extended length of stay (OR: 1.331) (p < 0.05). IDDM additionally increased the risk for acute renal failure (OR 3.269) and cardiac arrest (OR 3.268) (p < 0.05) when compared to Non-DM. DM patients overall had increased rates of worse outcomes and infectious complications. CONCLUSION Although differences between diabetes and non-diabetes rTKA patients were seen, differences in complication rates between diabetes patients further divided based on insulin dependence status were also noted. Future work examining whether targeting perioperative glucose levels <200 mg/dL in DM rTKA patients decreases infectious complications is warranted. Future work analyzing the role of tranexamic acid administration and 24-h postoperative antibiotics in rTKA IDDM patients may be warranted given the elevated risk of pneumonia, septic shock, and blood transfusions.
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Affiliation(s)
- Danny Lee
- The George Washington University School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
- Corresponding author. The George Washington University School of Medicine and Health Sciences, The George Washington University, 2300 I Street NW, Washington, DC, 20037, USA.
| | - Ryan Lee
- The George Washington University School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Nikhil B. Gowda
- The George Washington University School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - William V. Probasco
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Seth Stake
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - George Ibrahim
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
| | - Rajeev Pandarinath
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, USA
- Corresponding author. Department of Orthopaedic Surgery, George Washington University, 2300 M Street NW, 5th Floor, Washington, DC. 20037, USA.
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Rahmadi A, Decroli E, Kam A. Sepsis in Latent Autoimmune Diabetes in Adults with Diabetic Ketoacidosis: A Case Report. Open Access Maced J Med Sci 2019; 7:3501-3504. [PMID: 32002083 PMCID: PMC6980811 DOI: 10.3889/oamjms.2019.687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/15/2019] [Accepted: 09/16/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND This case report intends to highlight the challenge in diagnosing type 1 diabetes on an adult patient. Latent Autoimmune Diabetes in Adult (LADA) types I diabetes Mellitus, which found in adulthood and characterised by progressive damage to pancreatic β cells that happened slowly. Incidence of LADA is around 2-12% of the total diabetes population. Sepsis in LADA patients will trigger diabetic ketoacidosis (DKA). CASE REPORT We report a case of a 33-year-old woman patient presents with decreased consciousness accompanied by rapid and deep breathlessness for 1 day. Before, the patient complains of fever and cough. Physical examination found soporous, blood pressure 120/80 mmHg, pulse 110 x/minute, temperature 38.8°C, breathing 32 x/minute Kussmaul. Bronchovesicular breath crackles in both lower lung fields. leukocytes were 22,100/mm3, random blood glucose 638 mg/dL, urine ketone +++, HbA1C 17.2%, HOMA IR less than 2 units. C-peptide 0.3 ng/mL and GADAs 16.9 U/mL. Chest Xray indicated bronchopneumonia. Patients were diagnosed with diabetic ketoacidosis, LADA, and sepsis caused by bronchopneumonia. Patient treated with DKA management and sepsis. On the second day, the treatment of DKA was resolved and continued with the administration of short-acting insulin and regular long-acting. CONCLUSION Sepsis in LADA with DKA requires fast and appropriate management. Further search is needed to diagnose LADA.
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Affiliation(s)
- Afdol Rahmadi
- Department of Internal Medicine, Faculty of Medicine, Andalas University, M. Djamil General Hospital, Padang, Sumatera Barat, Indonesia
| | - Eva Decroli
- Department of Internal Medicine, Faculty of Medicine, Andalas University, M. Djamil General Hospital, Padang, Sumatera Barat, Indonesia
| | - Alexander Kam
- Department of Internal Medicine, Faculty of Medicine, Andalas University, M. Djamil General Hospital, Padang, Sumatera Barat, Indonesia
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Farsani SF, Brodovicz K, Soleymanlou N, Marquard J, Wissinger E, Maiese BA. Incidence and prevalence of diabetic ketoacidosis (DKA) among adults with type 1 diabetes mellitus (T1D): a systematic literature review. BMJ Open 2017; 7:e016587. [PMID: 28765134 PMCID: PMC5642652 DOI: 10.1136/bmjopen-2017-016587] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To summarise incidence and prevalence of diabetic ketoacidosis (DKA) in adults with type 1 diabetes (T1D) for the overall patient population and different subgroups (age, sex, geographical region, ethnicity and type of insulin administration). DESIGN Systematic literature review (SLR). DATA SOURCES Medline (via PubMed) and Embase (1 January 2000 to 23 June 2016). STUDY SELECTION Peer-reviewed observational studies with reported data on the incidence or prevalence of DKA in T1D adults were included. A single reviewer completed the study screening and selection process and a second reviewer performed an additional screening of approximately 20% of the publications; two reviewers independently conducted the quality assessment; the results were narratively synthesised. RESULTS Out of 1082 articles, 19 met the inclusion and exclusion criteria, with two additional studies identified that did not specify the patient age range and are therefore not included in the SLR. Overall, eight studies reported incidence with a range of 0-56 per 1000 person-years (PYs), with one outlying study reporting an incidence of 263 per 1000 PYs. Eleven studies reported prevalence with a range of 0-128 per 1000 people. Prevalence of DKA decreased with increasing age. Subgroup analyses were performed using data from no more than two studies per subgroup. There was a higher prevalence of DKA reported in women, non-whites and patients treated with insulin injections compared with men, whites and patients using continuous subcutaneous insulin infusion pumps, respectively. CONCLUSIONS To our knowledge, this is the first SLR on the epidemiology of DKA in T1D adults. Despite an increasing prevalence of T1D in recent years, DKA in adults has been poorly characterised. In an era when the benefit-risk profiles of new antidiabetic therapies are being evaluated, including the potential risk of DKA, there is a clear need to better elucidate the expected rate of DKA among T1D adults.
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Affiliation(s)
- Soulmaz Fazeli Farsani
- Corporate Department GlobalEpidemiology, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Kimberly Brodovicz
- Global Epidemiology, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, USA
| | | | - Jan Marquard
- Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim am Rhein, Germany
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