Causes of diabetic ketoacidosis: type 1 diabetes versus type 2 diabetes

Background: Diabetic Ketoacidosis (DKA) is one of the most commonly encountered diabetic complication emergencies. It typically affects people with type 1 diabetes at the onset of the disease. It can also affect people with type 2 diabetes, although this is uncommon. Methods: Research and online content related to diabetes online activity is reviewed. DKA is caused by a relative or absolute deficiency of insulin and elevated levels of counter regulatory hormones. Results: Goals of therapy are to correct dehydration, acidosis and to reverse ketosis, gradually restoring blood glucose concentration to near normal. Conclusion: Furthermore it is essential to monitor potential complications of DKA and if necessary, to treat them and any precipitating events.

Download Full-text

Incidence and associates of diabetic ketoacidosis in a community-based cohort: the Fremantle Diabetes Study Phase II

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-000983 ◽

2020 ◽

Vol 8 (1) ◽

pp. e000983

Author(s):

Timothy M E Davis ◽

Wendy Davis

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Diabetic Ketoacidosis ◽

Phase Ii ◽

Negative Binomial ◽

Study Phase ◽

Community Based ◽

Secondary Diabetes

ObjectiveTo assess the incidence and associates of diabetic ketoacidosis (DKA) in a representative community-based cohort.MethodsAll hospitalizations of 1724 participants in the Fremantle Diabetes Study Phase II for/with DKA (plasma glucose >13.8 mmol/L, urinary/serum ketones, serum bicarbonate <18 mmol/L and/or arterial/venous pH <7.30) were identified between study entry from 2008 to 2011 and end-2013. Details of each episode were categorized by chart review as confirmed/probable DKA, possible DKA or not DKA. Incidence rates by diabetes type were calculated. Cox proportional hazards modeling determined predictors of first episode, and negative binomial regression identified predictors of frequency.ResultsThere were 53 coded DKA episodes (41 first episodes, 12 recurrences), of which 19 (35.8%) were incorrectly coded, 9 (17.0%) had possible DKA and 25 (47.2%) had confirmed/probable DKA. Of this latter group, 44% had type 1 diabetes, 32% had type 2 diabetes, 12% had latent autoimmune diabetes of adults (LADA) and 12% had secondary diabetes. The overall incidence of confirmed/probable DKA (95% CI) was 35.6 (23.0 to 52.6)/10 000 person-years (178.6 (85.7 to 328.5)/10 000 person-years for type 1 diabetes, 13.3 (5.7 to 26.1)/10 000 person-years for type 2 diabetes, 121.5 (33.1 to 311.0)/10 000 person-years for LADA and 446.5 (92.1 to 1304.9)/10 000 person-years for secondary diabetes). Baseline ln(fasting serum C-peptide) (inversely), glycated hemoglobin and secondary diabetes predicted both incident first confirmed/probable DKA episode and the frequency of DKA (p<0.001).ConclusionsThese data highlight the contribution of poor glycemic control and limited pancreatic beta cell function to incident DKA, and show that people with types of diabetes other than type 1, especially secondary diabetes, are at risk.

Download Full-text

Diabetic ketoacidosis in childhood and adolescence

Oxford Textbook of Endocrinology and Diabetes ◽

10.1093/med/9780199235292.003.1473 ◽

2011 ◽

pp. 1888-1894 ◽

Cited By ~ 4

Author(s):

M. Silink

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Diabetic Ketoacidosis ◽

Hispanic Americans ◽

Viral Infections ◽

Childhood And Adolescence ◽

Oral Hypoglycaemic Agents ◽

Obesity Epidemic

Diabetic ketoacidosis (DKA) may occur at the time of diagnosis of diabetes, or at any time subsequently. It is the cause of very significant morbidity and remains the most common cause of death in childhood and adolescent diabetes (1–3). For a discussion of DKA in adults, see Chapter 13.4.10.1. Type 1 diabetes occurs in childhood (see Chapter 13.4.7) with an incidence that varies from more than 40 per year per 1 00 000 children under the age of 15 years old (in Finland), to less than 1 per 1 00 000 (in Asia). The mean age at diagnosis is usually 10–12 years old, although, in a number of countries, this seems to be declining. The younger the child is at diagnosis, the more aggressive the autoimmune-mediated destruction of the pancreatic β‎ cell, and the more rapid the progression to complete insulin dependence (see Chapter 13.2.3). Children are thus more liable to DKA than adults. Furthermore, children experience more viral infections than do adults, and the metabolic stresses associated with these infections increase their risk of developing DKA. DKA has traditionally been considered to occur only in type 1 diabetes, but is now being reported in at least 25% of (usually obese) adolescents with newly diagnosed type 2 diabetes, especially when there are associated stress factors, such as infection (4, 5). Although the vast majority of diabetes in childhood and adolescence is type 1 diabetes, there has been a worldwide trend to the earlier development of type 2 diabetes in association with the overweight and obesity epidemic, especially in certain at-risk ethnic groups, e.g. Asians, African Americans, Hispanic Americans; see Chapter 13.4.3.1. The treatment of DKA in these patients is the same as for those with type 1 diabetes; however, the subsequent course of the treatment usually differs, and most patients are able to stop insulin and be treated with oral hypoglycaemic agents, weight reduction, exercise, and an appropriate food plan.

Download Full-text

Clinical and biochemical profile of 786 sequential episodes of diabetic ketoacidosis in adults with type 1 and type 2 diabetes mellitus

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2021-002451 ◽

2021 ◽

Vol 9 (2) ◽

pp. e002451

Author(s):

Emma Ooi ◽

Katrina Nash ◽

Lakshmi Rengarajan ◽

Eka Melson ◽

Lucretia Thomas ◽

...

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Diabetic Ketoacidosis ◽

Tertiary Care ◽

Final Analysis ◽

Care Hospital ◽

Hospital Data ◽

Management Protocol

IntroductionWe explored the clinical and biochemical differences in demographics, presentation and management of diabetic ketoacidosis (DKA) in adults with type 1 and type 2 diabetes.Research design and methodsThis observational study included all episodes of DKA from April 2014 to September 2020 in a UK tertiary care hospital. Data were collected on diabetes type, demographics, biochemical and clinical features at presentation, and DKA management.ResultsFrom 786 consecutive DKA, 583 (75.9%) type 1 diabetes and 185 (24.1%) type 2 diabetes episodes were included in the final analysis. Those with type 2 diabetes were older and had more ethnic minority representation than those with type 1 diabetes. Intercurrent illness (39.8%) and suboptimal compliance (26.8%) were the two most common precipitating causes of DKA in both cohorts. Severity of DKA as assessed by pH, glucose and lactate at presentation was similar in both groups. Total insulin requirements and total DKA duration were the same (type 1 diabetes 13.9 units (9.1–21.9); type 2 diabetes 13.9 units (7.7–21.1); p=0.4638). However, people with type 2 diabetes had significantly longer hospital stay (type 1 diabetes: 3.0 days (1.7–6.1); type 2 diabetes: 11.0 days (5.0–23.1); p<0.0001).ConclusionsIn this population, a quarter of DKA episodes occurred in people with type 2 diabetes. DKA in type 2 diabetes presents at an older age and with greater representation from ethnic minorities. However, severity of presentation and DKA duration are similar in both type 1 and type 2 diabetes, suggesting that the same clinical management protocol is equally effective. People with type 2 diabetes have longer hospital admission.

Download Full-text

Family history of diabetes and distribution of class II HLA genotypes in children with newly diagnosed type 1 diabetes: effect on diabetic ketoacidosis

Acta Endocrinologica ◽

10.1530/eje-11-0376 ◽

2011 ◽

Vol 165 (5) ◽

pp. 813-817 ◽

Cited By ~ 23

Author(s):

Anne Hekkala ◽

Jorma Ilonen ◽

Mikael Knip ◽

Riitta Veijola ◽

_ _

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Family History ◽

Diabetic Ketoacidosis ◽

Family History Of Diabetes ◽

Hla Dr ◽

Hla Genotypes ◽

History Of

ObjectiveOur purpose was to assess whether family history of diabetes or the HLA-DR-DQ genotype of the index case was associated with the frequency of diabetic ketoacidosis (DKA) at diagnosis of childhood type 1 diabetes.Patients and methodsThe study cohort comprised 1518 children aged <15 years and diagnosed with type 1 diabetes in Finland in 2002–2005. Family history of type 1 and type 2 diabetes among first-degree relatives (FDRs) and grandparents was assessed at diagnosis. HLA-DR-DQ genotypes were analysed using time-resolved fluorometry.ResultsIn total, 12.6 and 1.7% of children had at least one FDR affected with type 1 or type 2 diabetes, respectively, and 6.6 and 34.8% had at least one grandparent with type 1 or type 2 diabetes. DKA (pH <7.30) occurred less frequently in children having a type 1 diabetes affected FDR (7.4 vs 20.5%, P<0.001). Type 2 diabetes among the parents or grandparents had no such effect. Lower risk HLA genotypes were observed to predispose to DKA (P<0.024). In a logistic regression analysis, the risk of DKA was independently associated with the absence of a family member affected by type 1 diabetes, the presence of a low-risk HLA genotype and older age at diagnosis (odds ratio 3.23, 1.45 and 1.07 respectively).ConclusionThe presence of type 1 diabetes in an FDR is associated with an decreased risk of DKA at diagnosis. The rate of DKA seems to be higher in children with lower HLA-conferred risk for type 1 diabetes.

Download Full-text

Diabetic ketoacidosis

InnovAiT Education and inspiration for general practice ◽

10.1177/1755738017735779 ◽

2017 ◽

Vol 10 (12) ◽

pp. 721-727

Author(s):

Victoria McAllister

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Diabetic Ketoacidosis ◽

Morbidity And Mortality ◽

Threatening Condition ◽

Life Threatening

Diabetic ketoacidosis is a potentially life-threatening condition that affects people with diabetes mellitus. It typically affects people with type 1 diabetes and can be a first presentation for people not yet diagnosed. It can also affect people with type 2 diabetes, although this is much more uncommon. This article aims to increase understanding of a condition where prompt recognition and rapid management by GPs is essential in preventing morbidity and mortality.

Download Full-text

1746-P: Obese Youth with Type 1 Diabetes (T1D) Have Worse Hepatic Insulin Resistance (IR) Than Youth with Type 2 Diabetes (T2D)

Diabetes ◽

10.2337/db20-1746-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 1746-P

Author(s):

PATTARA WIROMRAT ◽

MELANIE CREE-GREEN ◽

BRYAN C. BERGMAN ◽

KALIE L. TOMMERDAHL ◽

AMY BAUMGARTNER ◽

...

Keyword(s):

Insulin Resistance ◽

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Hepatic Insulin Resistance ◽

Obese Youth

Download Full-text

1264-P: Distinguishing between Obese Patients with Type 1 Diabetes (T1DMob) and Type 2 Diabetes in Adolescence (T2DMad) at Presentation

Diabetes ◽

10.2337/db20-1264-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 1264-P

Author(s):

FABRIZIO BARBETTI ◽

RICCARDO BONFANTI ◽

MAURIZIO DELVECCHIO ◽

DARIO IAFUSCO ◽

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Obese Patients

Download Full-text

110-OR: Type 2 Diabetes (T2D)–Associated TCF7L2 Genetic Variants and Indices of Insulin Secretion and Sensitivity in Individuals at Risk for Type 1 Diabetes (T1D)

Diabetes ◽

10.2337/db20-110-or ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 110-OR

Author(s):

MARIA J. REDONDO ◽

MEGAN V. WARNOCK ◽

LAURA E. BOCCHINO ◽

SUSAN GEYER ◽

ALBERTO PUGLIESE ◽

...

Keyword(s):

Type 2 Diabetes ◽

At Risk ◽

Type 1 Diabetes ◽

Insulin Secretion ◽

Genetic Variants

Download Full-text

Model estimates of the results of diabetes patients using modern glucometers with tri-color technology for displaying test results

Medical Technologies Assessment and Choice (Медицинские технологии Оценка и выбор) ◽

10.31556/2219-0678.2019.37.3.081-089 ◽

2019 ◽

pp. 81-89

Author(s):

Larisa Dmitrievna Popovich ◽

Svetlana Valentinovna Svetlichnaya ◽

Aleksandr Alekseevich Moiseev

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Economic Benefits ◽

Test Results ◽

Self Monitoring ◽

Patients With Diabetes ◽

The Impact

Diabetes – a disease in which the effect of the treatment substantially depends on the patient. Known a study showed that the use of glucometers with the technology of three-color display of test results facilitates self-monitoring of blood sugar and leads to a decrease in glycated hemoglobin (HbAlc). Purpose of the study: to modeling the impact of using of a glucometer with a color-coded display on the clinical outcomes of diabetes mellitus and calculating, the potential economic benefits of reducing the hospitalization rate of patients with diabetes. Material and methods. Based on data from two studies (O. Schnell et al. and M. Baxter et al.) simulation of the reduction in the number of complications with the use of a glucometer with a color indication. In a study by O. Schnell et al. a decrease of HbA1c by 0.69 percent is shown when using the considered type of glucometers, which was the basis of the model. Results. In the model, the use of a glucometer with a color-coded display for type 1 diabetes led to a decrease in the total number of complications by 9.2 thousand over 5 years per a cohort of 40 thousand patients with different initial levels of HbA1c. In a cohort of 40 thousand patients with type 2 diabetes, the simulated number of prevented complications was 1.7 thousand over 5 years. When extrapolating these data to all patients with diabetes included in the federal register of diabetes mellitus (FRD), the number of prevented complications was 55.4 thousand cases for type 1 diabetes and 67.1 thousand cases for type 2 diabetes. The possible economic effect from the use of the device by all patients with a diagnosis of diabetes, which are included in the FRD, estimated at 1.5 billion rubles for a cohort of patients with type 1 diabetes and 5.3 billion rubles for patients with type 2 diabetes. Conclusion. Improving the effectiveness of self-monitoring, which is the result of the use of glucometers with color indicators, can potentially significantly reduce the incidence of complications in diabetes and thereby provide significant economic benefits to society.

Download Full-text