Diabetic ketoacidosis in southern Jordan: five-year experience

All cases of diabetic ketoacidosis admitted to Prince Zaid Hospital between 1993 and 1997 were analysed for precipitating causes and outcome. Of 167 cases, 89 were male and 78 female, with a mean age of 38 years. It was the initial presentation of diabetes mellitus in 21% of the patients. Infection and noncompliance were the leading precipitating causes but no cause was found in 14% of the patients. The mortality rate was 4.8%. Educating the public and patients about diabetic complications and therapy is the key to prevention of diabetic ketoacidosis.

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Diabetic ketoacidosis among SGLT2i-treated patients: insight from a single medical center located in the region with the highest diabetes mellitus mortality rate in Israel

Endocrine Abstracts ◽

10.1530/endoabs.56.p437 ◽

2018 ◽

Author(s):

Anat Jaffe ◽

Naomi Dafni ◽

Galith Haran

Keyword(s):

Diabetes Mellitus ◽

Mortality Rate ◽

Diabetic Ketoacidosis ◽

Medical Center

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Frequency, clinical characteristics, biochemical findings and outcomes of DKA at the onset of type-1 DM in young children and adolescents living in a developing country – an experience from a pediatric emergency department

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2018-0324 ◽

2019 ◽

Vol 32 (2) ◽

pp. 115-119 ◽

Cited By ~ 3

Author(s):

Amna Jawaid ◽

Arjumand Sohaila ◽

Nadia Mohammad ◽

Unaib Rabbani

Keyword(s):

Diabetes Mellitus ◽

Emergency Department ◽

Developing Countries ◽

Type 1 Diabetes ◽

Mortality Rate ◽

Children And Adolescents ◽

Diabetic Ketoacidosis ◽

Clinical Characteristics ◽

Incidence And Mortality

Abstract Background As per the International Society for Pediatrics and Adolescent Diabetes (ISPAD) census, diabetic ketoacidosis (DKA) is the most frequent cause of diabetes-related death. In developing countries, DKA-related mortality rate ranges from 6% to 24% (Onyiriuka AN, Ifebi E. Ketoacidosis at diagnosis of type 1 diabetes in children and adolescents: frequency and clinical characteristics. J Diabetes Metab Disord 2013;12:47) in contrast to 0.15%–0.31% in the Western world (Poovazhagi V. Risk factors for mortality in children with diabetic ketoacidosis from developing countries. World J Diabetes 2014;5:932–93.). In developing countries like Pakistan, the situation is more perplexing owing to uncertain or under-reported statistics about the spectrum of the disease and its prevalence, coupled with limited access to medical care and experts as well as less awareness. These limitations restrict our ability to develop interventions that are patient-centered. Our main objective was to determine the severity, clinical features, bio-chemical findings and outcomes of DKA in children aged 1 month to 16 years. Subjects and methods This retrospective study included the analysis of medical and laboratory records from patients’ medical charts and the electronic database of all children aged 1 month to 16 years with newly diagnosed type-1 diabetes mellitus (T1DM) complicated with ketoacidosis, who presented to the emergency department (ED) at the Aga Khan University Hospital (AKUH), between January 2009 and December 2014. Results Diabetes mellitus complicated with DKA was the predominant diagnosis (n=113 [75.83%]) among endocrine diseases in children visiting the ED. Our study witnessed an increase in the incidence of DKA particularly after 5 years of age, with more severity in females. In our study, the mortality rate was 3.4%. Conclusions Considering the high incidence and mortality rate, it is emphasized that DKA should be considered in differential diagnosis. An awareness campaign for both general pediatricians and physicians as well as for the public is needed for better outcomes.

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Knowledge about Complications of Diabetes in Diabetic Patients Attending in General Health Checkup, Tribhuvan University Teaching Hospital Nepal

International Journal of Diabetes & Metabolic Disorders ◽

10.33140/ijdmd/03/03/00008 ◽

2018 ◽

Vol 3 (3) ◽

Keyword(s):

Diabetes Mellitus ◽

Diabetic Ketoacidosis ◽

Teaching Hospital ◽

Diabetic Complications ◽

General Health ◽

Health Check ◽

University Teaching ◽

Diabetic Patients ◽

Complications Of Diabetes ◽

Duration Of Diabetes

Introduction: The prevalence of diabetes mellitus has risen exponentially over the last three decades, with resultant increase in morbidity and mortality mainly due to its complications. The study aimed to assess the knowledge about the complications of diabetes in diabetic patients. Methods: A cross-sectional observational study was conducted among 100 diabetic patients who attended general health check-up clinic of Tribhuvan University Teaching Hospital. Results: Majority of the female patients (78.8%) had the knowledge of diabetes mellitus. Among them, over half had knowledge that diabetes can cause the problem of cardiovascular, kidney failure and retinopathy .Similarly, four-fifths (80%) of the patients above 40 years of age and majority (92.3%) of the patients with more than 5 years duration of diabetes had knowledge about diabetic complications. Conclusion: Female diabetic patients had slightly more knowledge of complication of diabetes in comparison to their male counterparts. The knowledge of diabetic complication was generally high among the patients above 40 years of age and the patients with more than 5 years duration of diabetes. Even then, sex and age was not associated with the knowledge of the need for annual eye checkup and specific diabetic complications such as, kidney and cardiovascular problem, hypoglycemia, neuropathy, foot problem, retinopathy, diabetic ketoacidosis and stroke. However, duration of patient’s diabetics was associated with their knowledge regarding cardiovascular problem, eye check-up annual and retinopathy but was not associated with kidney problem, hypoglycemia, neuropathy, foot problem, diabetic ketoacidosis and stroke. In order to make patient along with their family knowledgeable about the diabetes and its complications, there is need to incorporate diabetes counseling and education activities in General Health Check Up Clinic.

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Tatalaksana Penurunan Kesadaran Pada Penderita Diabetes Mellitus

Medicinus ◽

10.19166/med.v6i1.1139 ◽

2018 ◽

Vol 6 (1) ◽

Author(s):

Ian Huang

Keyword(s):

Diabetes Mellitus ◽

Mortality Rate ◽

Lactic Acidosis ◽

Diabetic Ketoacidosis ◽

Complications Of Diabetes ◽

Uremic Encephalopathy ◽

Hyperosmolar Hyperglycemic State ◽

Life Threatening

Hyperglycemic crisis (diabetic ketoacidosis or hyperosmolar hyperglycemic state), lactic acidosis, hypoglycemia, and uremic encephalopathy are life-threatening complications of diabetes mellitus (DM). Specific therapies of each condition are essential in reducing mortality rate of the complications.

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The management of diabetic ketoacidosis at a rural regional hospital in KwaZulu-Natal

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v10i1.1612 ◽

2018 ◽

Vol 10 (1) ◽

Cited By ~ 3

Author(s):

Nontobeko F.M. Ndebele ◽

Mergan Naidoo

Keyword(s):

Diabetes Mellitus ◽

Mortality Rate ◽

Diabetic Ketoacidosis ◽

Length Of Hospital Stay ◽

Glycated Haemoglobin ◽

Regional Hospital ◽

Metabolic Complications ◽

Black South African ◽

Presenting Symptoms ◽

African Patients

Background: Diabetic ketoacidosis (DKA) is a biochemical triad of hyperglycaemia, ketoacidosis and ketonaemia and one of the potentially life-threatening acute metabolic complications of diabetes mellitus. This study aimed at describing the clinical profile of patients presenting with DKA to a busy rural regional hospital in KwaZulu-Natal.Methods: A retrospective review of clinical notes of patients presenting with DKA to the Emergency Department was performed over a 10-month period. Data included patients’ demographic profile, clinical presentation, precipitating factors, comorbidities, biochemical profile, length of hospital stay and outcome.Results: One hundred and five black South African patients above the age of 12 years were included in the study. Sixty-four (60.95%) patients had type 1 diabetes mellitus (T1DM) and 41 (39.05%) patients had type 2 diabetes mellitus (T2DM). Patients with T2DM were significantly older than those with T1DM (52.1 ± 12.4 years vs. 24.4 ± 9.5 years, p < 0.0001). The acute precipitant was identified in 68 (64.76%) cases with the commonest precipitant in T1DM patients being poor adherence to treatment, whereas in T2DM, the most common precipitant was infection. Nausea and vomiting were the most common presenting symptoms with the majority of patients presenting with non-specific symptoms. Fifty-seven (54.29%) cases had pre-existing comorbidities, with higher prevalence in T2DM than T1DM patients. Glycated haemoglobin was severely elevated in the majority of patients. Patients remained hospitalised for an average of 8.9 ± 7.5 days. The mortality rate was 17.14%, and 12 of the 18 deaths occurred in patients with T2DM.Conclusion: The prevalence of DKA was higher in patients with T1DM and those with pre-existing comorbidities. The mortality rate remains alarmingly high in older patients with T2DM.

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P131: Risk factors for recurrent emergency department visits for hyperglycemia in patients with diabetes mellitus

CJEM ◽

10.1017/cem.2017.333 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S122 ◽

Cited By ~ 1

Author(s):

J.W. Yan ◽

K. Gushulak ◽

M. Columbus ◽

K. Van Aarsen ◽

A. Hamelin ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Emergency Department ◽

Protective Factors ◽

Diabetic Ketoacidosis ◽

Initial Presentation ◽

Patients With Diabetes ◽

Hyperosmolar Hyperglycemic State ◽

Ed Visits ◽

One Year

Introduction: Patients with poorly controlled diabetes mellitus may present repeatedly to the emergency department (ED) for management and treatment of hyperglycemic episodes, including diabetic ketoacidosis and hyperosmolar hyperglycemic state. The objective of this study was to identify risk factors that predict unplanned recurrent ED visits for hyperglycemia in patients with diabetes within 30 days of initial presentation. Methods: We conducted a one-year health records review of patients ≥18 years presenting to one of four tertiary care EDs with a discharge diagnosis of hyperglycemia, diabetic ketoacidosis or hyperosmolar hyperglycemic state. Trained research personnel collected data on patient characteristics and determined if patients had an unplanned recurrent ED visit for hyperglycemia within 30 days of their initial presentation. Multivariate logistic regression models using generalized estimating equations to account for patients with multiple visits determined predictor variables independently associated with recurrent ED visits for hyperglycemia within 30 days. Results: There were 833 ED visits for hyperglycemia in the one-year period. 54.6% were male and mean (SD) age was 48.8 (19.5). Of all visitors, 156 (18.7%) had a recurrent ED visit for hyperglycemia within 30 days. Factors independently associated with recurrent hyperglycemia visits included a previous hyperglycemia visit in the past month (odds ratio [OR] 3.5, 95% confidence interval [CI] 2.1-5.8), age <25 years (OR 2.6, 95% CI 1.5-4.7), glucose >20 mmol/L (OR 2.2, 95% CI 1.3-3.7), having a family physician (OR 2.2, 95% CI 1.0-4.6), and being on insulin (OR 1.9, 95% CI 1.1-3.1). Having a systolic blood pressure between 90-150 mmHg (OR 0.53, 95% CI 0.30-0.93) and heart rate >110 bpm (OR 0.41, 95% CI 0.23-0.72) were protective factors independently associated with not having a recurrent hyperglycemia visit. Conclusion: This unique ED-based study reports five risk factors and two protective factors associated with recurrent ED visits for hyperglycemia within 30 days in patients with diabetes. These risk factors should be considered by clinicians when making management, prognostic, and disposition decisions for diabetic patients who present with hyperglycemia.

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Implementation of Diabetes Mellitus Program in the Tyumen region

Diabetes Mellitus ◽

10.14341/2072-0351-5418 ◽

2009 ◽

Vol 12 (1) ◽

pp. 33-35

Author(s):

Lyudmila Alexandrovna Suplotova ◽

L N Belchikova ◽

N S Brynza

Keyword(s):

Diabetes Mellitus ◽

Mortality Rate ◽

Life Expectancy ◽

Diabetic Complications ◽

Hypoglycemic Agents ◽

Diabetic Coma ◽

Oral Hypoglycemic Agents ◽

High Quality ◽

Disability Rate ◽

Primary Disability

Aim. To assess results of realization of the regional Diabetes Mellitus Program in the Tyumen region. Materials and methods. Materials of the regional Diabetes Mellitus Registry for 1999-2007 were analysed. Results. DM1 and DM2 morbidity increased from 6.6 to 8.16 and from 97.3 to 216.96 per100,000 population respectively. Primary disability rate among DM1 and DM2 patientsdecreased by a factor of 2. The fraction of patients with severe diabetic complications also decreased (1.3 times for blindness, 1.8 times for amputations). The frequency of diabeticcoma decreased by a factor of 2. Thirty five Diabetes School were organized. Mean life expectancy of DM1 and DM2 subjects increased from 49.55?5.43 to 50.11?2.96 years(p = 0.0001) and from 68.00?1.79 to 71.52?0.39 years (r = 0.0001) respectively. Mortality rate in DM1 and DM2 patients dropped by a factor of 5 and 3. All DM patients use onlymodern insulin formulations, with analogs accounting for 39.5% and human recombinant insulins for the rest of the total. Therapeutic use of secretagogues for the managementof DM2 decreased from 84.8 to 49.1% (p = 0.0001) and that of metformin increased form 6.8 to 28% (p = 0.0001); the need in insulin therapy also increased. Conclusion. Elaboration and implementation of the program contributed to the decreased occurrence of diabetic coma, blindness, and amputations in DM1 and DM2 patients,their longer life expectancy, and improved availability of high-quality oral hypoglycemic agents.

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