Diabetes
Emma Ooi 1 , Katrina Nash 2 , Lakshmi Rengarajan 3 , Eka Melson 4 , Lucretia Thomas 2 , Agnes Johnson 2 , Dengyi Zhou 2 , Lucy Wallett 3 , Sandip Ghosh 3 , Parth Narendran 5 & Punith Kempegowda 4
1RCSI & UCD Malaysia Campus; [email protected]; 2College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; 3University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 4University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Metabolism and Systems Research, University of Birmingham, UK; 5University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Immunology and Immunotherapy, University of Birmingham, UK
Objectives: We explored the differences in severity and outcomes of diabetic ketoacidosis (DKA) in people with type 1 (T1DM) and type 2 diabetes (T2DM).
Methods: All DKA episodes from April 2014 to September 2020 at a tertiary care centre in the United Kingdom were identified. People admitted with DKA were classified as having T1DM or T2DM based on previously established diagnosis, autoantibody status, and/or phenotypic features. We compared the differences in severity at presentation (pH, bicarbonate, glucose, lactate, serum osmolality, urea), complications during management (hypoglycaemia, hypo- or hyperkalemia), total DKA duration and length of stay between the two groups.
Results: A total of 768 DKA episodes were included [T1DM: 75.9% (n=583/768); T2DM: 24.1% (n=185/768)]. There was no difference in severity as assessed by biochemical profiles on admission [median pH (T1DM vs T2DM: 7.22 vs 7.24; P=0.3266), bicarbonate (11.90 vs 13.20; P=0.2192), glucose (28.00 vs 26.55; P=0.4496), lactate (2.6 vs 2.6; P=0.6532), serum osmolality (310.07 vs 312.13; P=0.2787)] between the two groups, except for urea, which was higher in T2DM [7.1 vs 8.9; p<0.0001]. People with T1DM had more episodes of hypoglycaemia [median (interquartile range) T1DM 0(0-1); T2DM 0(0-0); P=0.0056] during DKA management. There was no difference in the number of episodes of hypokalaemia [T1DM: 0(0-1); T2DM: 0(0-1); P=0.3229] or hyperkalaemia [T1DM: 0(0-0); T2DM: 0(0-0); P=0.1356] during treatment for DKA. Although there was no difference in total DKA duration between the two groups [median; T1DM vs T2DM: 13.92 vs 13.90; P=0.4638], people with T2DM had significantly longer hospital stay [median; T1DM vs T2DM: 2.95 vs 11.02; P<0.0001].
Conclusions: Both T1DM and T2DM groups with DKA had similar severity at presentation and total duration suggesting the existing guidelines for DKA management caters for both groups. People with T2DM required a longer hospital stay, suggesting a need for more complex care.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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