Endocrine Abstracts

Introduction: Diabetes-related Ketoacidosis (DKA) is a commonly-encountered acute endocrine emergency requiring prompt recognition and treatment. DKA is triggered by risk factors that are often preventable. There are limited studies evaluating the precipitating causes of DKA and depicting their trends over the years. The latter is important in the prevention of DKA by ensuring appropriate education and interventions.

Aim: To study the trends of aetiologies that precipitate DKA over the years.

Methods: We conducted a retrospective analysis of all DKA related admissions across six regional hospitals in the United Kingdom between April 2014 to November 2021. DKA was diagnosed as serum glucose ≥11 mmol/l, ketones ≥ 3 mmol/l and pH ≤7.3 or bicarbonate ≤ 15 mmol/l. Precipitating factors were classified as Alcohol-related, COVID-19, Drug-induced, Intercurrent illness, New Diagnosis of type-1 diabetes, SGLT-2 inhibitor-associated, Sepsis, Suboptimal compliance to treatment and Trauma respectively. Statistical analysis was done using SPSS version 27. Results are expressed in percentage and proportion.

Results: A total of 1463 DKA episodes were included in the analysis. Intercurrent illness (34.8%, n=509) and Suboptimal compliance to treatment (28.2%, n=413) were the most common factors identified. Other notable causes of DKA were: New diagnosis of type 1 diabetes (8.9%n=130), Sepsis (4.2%, n=62), Alcohol-related (3.9%, n=57). The proportion of these aetiologies has remained consistent over the years. Newer varieties of precipitating causes such as SGLT2 inhibitor-associated (1.3%, n=19) and other Drug-induced (1.1%, n=16) had an increasing trend since 2019. COVID-19 accounted for 5% of the total episodes (n=41). Precipitating aetiology was unclear in 8%(n=187) of the DKA admissions. However, the proportion of unclear causes as precipitating aetiology for DKA has been steadily down trending since 2016 (24.0% in 2016, 19.2% in 2017, 14.5% in 2018, 16.2% in 2019, 12.6% in 2020 and 8.0% in 2021)

Conclusion: Infections and Suboptimal compliance to treatment accounted for a majority of 63% of the DKA cases, suggesting more work needs to be done to minimize these preventable causes. A rise in medication-induced DKA prompts the need to educate patients and clinicians to be aware of the role of these contributory medications. Down trending seen in Unclear Causes of DKA is a welcome result as this can help us prevent recurrences in patients by educating them regarding the known or established precipitating factors so that they could be vigilant in regards to these in future.