Endocrine Abstracts

Background & Objectives: Type 1 diabetes mellitus (T1DM) is a complex disease with both genetic and environmental factors in its pathophysiology. Higher risks of diabetic emergencies such as diabetic ketoacidosis (DKA) confers a greater difficulty in its management than Type 2 diabetes. This study aims to describe and compare the characteristics, management and outcomes of T1DM patients with and without complication of DKA.

Methods: A total of 333 T1DM patients who visited a tertiary hospital for clinic follow-up of T1DM in Singapore from May 2017 to October 2017 was studied. Patients were then stratified based on presence or absence of DKA after the initial diagnosis. Relevant demographics, pharmacological and non-pharmacological management and outcomes were analysed.

Results: Amongst the T1DM patients, 133 (39.9%) had at least one subsequent DKA episode while 200 patients (60.1%) did not. Greater proportion of patients with subsequent DKA episodes first presented with DKA before diagnosis of T1DM (DKA 62.7% vs No DKA 34.2%, P<0.01). Average HbA1c over the last 1-year was higher in patients with DKA than those without DKA (DKA 9.52±1.85% vs. No DKA 8.55±1.72%, P<0.01). Incidence of microvascular complications were higher in patients with DKA (50.0% vs 33.5%, P<0.01) while incidence of macrovascular complications was similar in both groups (12.9% vs 14.5%, P=0.70). Furthermore, hypoglycemic admissions were more common in patients with DKA (24.8% vs 10.0%, P<0.01). In terms of non-pharmacological management, compliance to self-blood glucose monitoring (59.4% vs 73.9%, P<0.01) and DM education class uptake (7.5% vs 22.6%, P<0.01) was poorer in patients with DKA than those without DKA. However, there was no significant difference seen in use of continuous glucose monitoring (DKA: 15.8% vs no DKA: 22.6%, P=0.13) or use of insulin pumps (4.0% vs 2.3%, P=0.54).

Conclusion: This study highlights the differences in characteristics, complications and management of T1DM with and without subsequent DKA episodes. It suggests that increased emphasis on educating management of hypoglycaemia and DM education classes would be beneficial for the control of T1DM. Moreover, importance of compliance to self-blood glucose monitoring should also be reinforced. Further studies will be required to optimise management of T1DM patients and to prevent future diabetic emergencies in these patients.