Endocrine Abstracts (2017) 49 EP463 | DOI: 10.1530/endoabs.49.EP463

Incidence of diabetic ketosis and ketoacidosis in Caucasian adults with type 2 diabetes mellitus: a population-based study

Petra Ćaćić1, Ivan Kruljac2, Miroslav Ćaćić2, Božidar Perić2, Maja Filipović-Grčić2, Gorana Mirošević2 & Milan Vrkljan1,2


1University of Zagreb School of Medicine, Zagreb, Croatia; 2University Hospital Center ‘Sestre Milosrdnice’, Zagreb, Croatia.


Aims: Diabetic ketosis (DK) and diabetic ketoacidosis (DKA) are known complications of type 1 diabetes mellitus (T1DM). However, DK and DKA have been described in T2DM. Referred to as ketosis-prone T2DM, this subtype of T2DM has been described in Hispanics and Afro-Americans of sub-Saharan Africa, but the incidence and pathogenesis remains unknown. We aimed to analyze characteristics of patients with diabetic ketosis (DK) and diabetic ketoacidosis (DKA) in Caucasian adults with T2DM.

Methods: Studied population included 261 749 adults. DK criteria included plasma glucose >13.9 mmol/l, and ketonuria >2; while in DKA bicarbonate <18 mEq/l or pH<7.30 was also required. Hyperglycemic crises without these criteria were defined as non-ketotic hyperglycemia (NKH).

Results: During 5-year period, we observed 630 episodes of DK and 215 episodes of DKA. Only 8.6% of DK episodes and 34.4% of DKA were attributed to T1DM. Patients with T1DM were younger, leaner, majority had newly diagnosed disease, and hyperglycemia was the main cause of admission. Stadardized incidence ratio for DK was 48.1 (95% CI 44.5–52.1) and 17.0 (95% CI 14.9–19.4) for DKA. Incidence for both DK and DKA was increasing with age. Patients with T2DM had a risk of 0.8% for developing DKA and 2.9% for DK over 5-year period.

Conclusions: Our study showed that DK and DKA are not uncommon in Caucasian adults and the majority of episodes were contributed to T2DM. Further studies are needed to assess the impact of these clinical entities.

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