Endocrine Abstracts

Introduction and objectives: Diabetic ketoacidosis (DKA) is a severe acute complication of Diabetes Mellitus (DM) and may require hospital admission. Our aim was to compare the characteristics of DKA occurring in patients with autoimmune DM (AMD) and type 2 DM (DM2) in our setting.

Methods: Retrospective observational study. Patients with AMD and DM2 admitted for DKA at the Hospital Universitario San Cecilio de Granada between January 2019 and December 2023 were compared. Variables related to the disease and to the episode of CAD were analyzed. Analyses were carried out with SPSS 25.0.

Results: 85 patients with AMD and 16 with DM2 were included (48.5% women, with no significant differences between the two groups). The mean age was significantly higher in DM2 (35.21 vs. 56.13 years, P<0.05) and the time of evolution was similar in both groups (15.37 ± 11.53 and 14.77 ± 9.97 respectively). BMI was significantly higher in the DM2 category (31.47 vs 21.4 kg/m², P<0.05). Admission for CAD was the manner of debut in 25.9% of patients with AMD and in 31.25% of DM2. Of the patients with AMD, 64.5% had previously presented an episode of DKA. The most important precipitating factor in AMD was omission of treatment while in DM2 it was concomitant infections. No significant differences were found in terms of the need for ICU stay or the number of days in the ICU and on the hospital ward between the two groups. In those patients with DM debut, patients with DM2 have higher basal and rapid insulin needs (31 vs 15.6 IU, P<0.05; and 34.67 vs 21.6 IU, P<0.05; respectively). Metabolic control in terms of HbA1c was worse, with a tendency to significance, in the AMD group (11.01 vs 10.02%, P=0.064). No significant differences were observed in analytical parameters (blood glucose, pH, HCO3 and lactic acid) at admission.

Conclusions: In our work, it was observed that admissions for DKA in our center were more frequent in patients with AMD, despite the fact that these present better metabolic control and lower insulin requirements at debut. On the other hand, there is a tendency for most episodes of DKA in DM2 to be associated with infections, while the main risk factor in patients with AMD is the omission of treatment.