Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2021) 73 AEP208 | DOI: 10.1530/endoabs.73.AEP208

ECE2021 Audio Eposter Presentations Diabetes, Obesity, Metabolism and Nutrition (223 abstracts)

Clinical and biochemical differences in diabetic ketoacidosis in people with type 1 and type 2 diabetes mellitus

Emma Ooi1, Lakshmi Rengarajan2, Eka Melson3, 4, Lucretia Thomas5, Agnes Johnson5, Dengyi Zhou5, Lucy Wallett2, Sandip Ghosh2, Parth Narendran2, 6 & Punith Kempegowda2, 4


1RCSI and UCD Malaysia Campus, George Town, Malaysia; 2University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 3Ninewells Hospital, NHS Tayside, Scotland, UK; 4Institute of Metabolism and Systems Research, University of Birmingham, UK; 5College of Medical and Dental Sciences, University of Birmingham, UK; 6Institute of Immunology and Immunotherapy, University of Birmingham, UK


Introduction

Once thought to typify type 1 diabetes mellitus (T1DM), diabetic ketoacidosis (DKA) in people with type 2 diabetes mellitus (T2DM) is also now increasingly recognized. We explored the clinical and biochemical differences in DKA in the two types of diabetes.

Methods

This retrospective cohort study included all the DKA episodes from April 2014 to September 2020 at a large tertiary care centre in West Midlands, United Kingdom. People admitted with DKA were classified as having T1DM or T2DM based on previously established diagnosis, treatment history, autoantibody status, and/or phenotypic features. The two groups were compared for differences in precipitating factors, biochemical profiles at presentation, management, and outcomes of the admission with DKA.

Results

A total of 786 DKA episodes were identified. Eighteen were excluded due to unclear underlying type of diabetes. 75.9% (n = 583/768) had T1DM, and 24.1% (n = 185/768) had T2DM. The most common precipitating causes in both groups were intercurrent illness (total: n = 272/768, 35.42%; T1DM: n = 198/583, 33.96%; T2DM: n = 74/185, 40.00%) and suboptimal compliance to treatment (total: n = 206/768, 26.82%; T1DM: n = 176/583, 30.19%; T2DM: n = 30/185, 16.22%). There was no clear precipitant in 16.15% (n = 124/768) (T1DM: n = 95/583, 16.30%; T2DM: n = 29/185, 15.68%). There was no significant difference in biochemical profiles on admission [median(Q1-Q3) pH (T1DM: 7.22(7.09–7.29); T2DM: 7.24(7.11–7.30); P = 0.3266), bicarbonate (T1DM: 11.90(7.13–16.78); T2DM: 13.20(7.75–17.80); P = 0.2192), glucose (T1DM: 28.00(20.45–34.80); T2DM: 26.55(16.21–35.09); P = 0.4496), lactate (T1DM: 2.6(1.8–4.3); T2DM: 2.6(2.04–4.21); P = 0.6532), serum osmolality (T1DM: 310.07(300.61–320.90); T2DM: 312.13(300.11–328.79); P = 0.2787)] between the two groups, except for urea, which was higher in T2DM [T1DM 7.1(5.1–10.6); T2DM 8.9(6.4–16.8); P < 0.0001]. There was no difference in appropriateness of fixed rate intravenous insulin infusion administered [T1DM: 100.00%(93.53–104.48); T2DM: 99.48%(90.00–102.27); P = 0.0688], proportion of hourly glucose measurements [T1DM: 99.49%(61.71–131.95); T2DM: 92.78% (64.33–120.22); P = 0.2143], proportion of hourly ketone measurements [T1DM: 46.39% (24.30–71.43); T2DM: 44.43% (20.90–70.74); P = 0.6485], and fluids administered [T1DM: 80.00% (58.33–100.00) vs 80.00% (50.00–112.50); P = 0.4978]. People with T1DM had more episodes of hypoglycaemia [T1DM 0(0–1); T2DM 0(0–0); P = 0.0056] during DKA management. Although there was no difference in the total DKA duration between the two groups [T1DM: 13.92(9.11–21.92); T2DM: 13.90(7.73–21.12); P = 0.4638], people with T2DM had significantly longer hospital stay [T1DM: 2.95(1.68–6.05); T2DM: 11.02(4.99–23.11)]; P < 0.0001].

Conclusion

Both cohorts had similar DKA severity, management, complications, and duration. People with T2DM required longer hospital stay, suggesting a more complex need for care, and increased economic burden. Increased awareness of DKA in people with T2DM is needed for improved prediction and prevention.

Volume 73

European Congress of Endocrinology 2021

Online
22 May 2021 - 26 May 2021

European Society of Endocrinology 

Browse other volumes

Article tools

My recent searches

No recent searches.