ECE2022 Rapid Communications Rapid Communications 10: Diabetes, Obesity, Metabolism and Nutrition 3 (8 abstracts)
Differences in prevalence of, and precipitating factors for, diabetes related ketoacidosis in type 1 and type 2 diabetes mellitus
Dengyi Zhou 1 , Haaziq Sheikh 2 , Dineshwaran Rajendran 3 , Shamanth Soghal 4 , Wai Nga Alice Yip 1 , Anjitha Anilkumar 1 , Meghnaa Hebbar 1 , Lakshmi Rengarajan 5 , Senthil Krishnasamy 6 & Parth Narendran 4
1University of Birmingham, College of Medical and Dental Sciences, Birmingham, United Kingdom; 2Haberdashers’ Adams’ Grammar School, Birmingham, United Kingdom; 3Good Hope Hospital, Sutton Coldfield, United Kingdom; 4Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom; 5Birmingham Heartlands Hospital, Birmingham, United Kingdom; 6Walsall Manor Hospital, Walsall, United Kingdom
Introduction: Diabetes related ketoacidosis (DKA) is usually associated with type 1 diabetes mellitus (T1DM). However, DKA is increasingly being recognised in type 2 diabetes mellitus (T2DM). We studied the differences in prevalence and precipitating factors of DKA between T1DM and T2DM.
Methods: This retrospective study included all DKA episodes from January to November 2021 in six hospitals in the West Midlands, UK. DKA was diagnosed as serum glucose≥11 mmol/l or known history of diabetes, ketones ≥ 3 mmol/l and pH ≤7.3 or bicarbonate ≤ 15 mmol/l as per Joint British Diabetes Societies guidelines. People admitted with DKA were classified as having T1DM or T2DM based on established diagnosis, autoantibody status, and/or phenotypic features. We compared the differences in prevalence and precipitating factors between these two groups.
Results: 465 episodes of DKA were identified. 47 were excluded from analysis due to unclear diabetes type. 68.7% (n=287/418) had T1DM and 31.3% (n=131/418) had T2DM. The differences in precipitating factors for DKA in T1DM vs T2DM were significant (P=0.006). The most common precipitating factor in both groups was intercurrent illness (T1DM: n=107/287, 37.3%; T2DM: n=57/131, 43.5%). More DKA episodes were precipitated by suboptimal compliance to treatment in T1DM compared to T2DM (T1DM: n=99/287, 34.5%; T2DM: n=20/131, 15.3%). 9 (6.9%) episodes of DKA were related to SGLT2 in T2DM compared to none in T1DM. 19 (6.6%) episodes of DKA were new diagnoses of T1DM. Other precipitating factors included COVID-19 (T1DM: n=14/287, 4.0%; T2DM: n=16/131, 12.2%), sepsis (T1DM: n=10/287, 3.5%; T2DM: n=11/131, 8.4%), alcohol (T1DM: n=12/287, 4.2%; T2DM: n=3/131, 2.3%), drug induced (T1DM: n=2/287, 0.7%; T2DM: n=3/131, 2.3%) and trauma (T1DM: n=2/287, 0.7%; T2DM: n=0/131, 0.0%).
Conclusion: DKA is no longer synonymous with T1DM and we are now seeing significant DKA case numbers in T2DM. The precipitating factors differed between the two types of diabetes and these results can help allocate resources for improved education and individualised clinical care appropriately to minimise morbidity and mortality associated with an eminently preventable condition.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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