Endocrine Abstracts

Introduction and methods: Despite advances in diabetes treatment, diabetic ketoacidosis (DKA) remains a significant cause of morbidity. We performed a 5-year retrospective analysis of DKA episodes (2004–2008). Results were compared with an earlier study (1997–2001).

Results: Ninety-four episodes of DKA (defined as hyperglycaemia, ketosis and acidosis) were identified through Hospital Inpatient Enquiry (HIPE). Patients with Type 1 diabetes mellitus (DM) accounted for 89% of episodes, Type 2 DM (6%) and pancreatic diabetes (4%). Mean patient age was 31.4±14.8 years with duration of diabetes 14.8±13.0 years. 57.4% of episodes occurred in females.

Mean length of hospital stay was 6.7±8.9 days, with 12.8% requiring admission to HDU/ITU (mean length of stay 4.4±3.6 days). Severe DKA (serum bicarbonate <10 mmol/l) occurred in 37.2%. One patient died during admission. Precipitants for DKA were poor compliance with insulin therapy (54.3%), infection (20.2%), first presentation with DM (11.7%), unknown in 8.5%, continuous subcutaneous insulin infusion pump failure in 3.2% and alcohol-related in 3.1%. Repeat offenders accounted for 36.2% of episodes, with addiction or social factors contributing significantly to these recurrent episodes.

There has been a 13% reduction in cases of DKA since the previous study. However, DKA in patients with Type 2 DM and pancreatic diabetes has increased (0.9% vs 10.6%, respectively). There was a 33% reduction in HDU/ICU admissions.

Conclusions: DKA remains a common cause of hospital admissions and omission of insulin continues to be the main precipitant. For repeat offenders, social and psychological support is required in the management of this vulnerable group.