Nyenwe Ebenezer, Loganathan Raghu, Blum Steve, Ezuteh Donald, Erani David, Palace Marcia, Ogugua Chukwuma
Department of Medicine, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, NY 10457, USA.
Metabolism. 2007 Feb;56(2):172-8. doi: 10.1016/j.metabol.2006.09.010.
Hospitalization for diabetic ketoacidosis (DKA) is increasing, perhaps due to the rising incidence of DKA in patients with type 2 diabetes mellitus (T2DM). Ethnic minority groups are at increased risk for T2DM. This study aimed at elucidating the characteristics of patients with ketosis-prone diabetes in a predominantly ethnic minority population. We performed a retrospective analysis of adults admitted with DKA at the Bronx Lebanon Hospital Center, Bronx, NY over 3 years. The patients were divided into cohorts based on type of diabetes and ethnicity. The cohorts were described and compared using statistical methods. We recorded 219 cases of DKA in 168 patients, 97% of whom were African American or Hispanic. Fifty-three (32%) patients had T2DM. New-onset diabetes, which was more common in T2DM (P < .0001), and African Americans (P = .008), occurred in 42 patients (25%). Readmission with DKA was more common in the Hispanic patients with type 1 diabetes mellitus (T1DM) (P = .0001). Type 2 diabetes mellitus was more prevalent in the African Americans (P = .04). Patients with T1DM had more severe acidosis than patients with T2DM (lower pH and bicarbonate and larger anion gap; P = .03, .02, and .005, respectively). Creatinine level was higher in patients with T2DM (P = .04) who were also less likely to have identifiable precipitating causes (P = .02). Hemoglobin A(1c) level was higher in patients with new-onset diabetes (P < .05), but did not differ between those with T1DM and T2DM. Mortality, which was 2%, occurred only in the African Americans with T2DM. We conclude that DKA is an important mode of initial presentation of T2DM, with new-onset T2DM accounting for about 60% of all new cases of DKA. African American patients with T2DM, in comparison with the Hispanic patients, are more susceptible to developing DKA. Diabetic ketoacidosis could occur in T2DM without any identifiable precipitant. The rising incidence of DKA may be attributable to its increasing occurrence in T2DM; therefore, measures aimed at primary prevention of T2DM are worthwhile.
糖尿病酮症酸中毒（DKA）的住院率正在上升，这可能归因于2型糖尿病（T2DM）患者中DKA发病率的增加。少数族裔群体患T2DM的风险更高。本研究旨在阐明以少数族裔为主的人群中易发生酮症的糖尿病患者的特征。我们对纽约州布朗克斯区黎巴嫩医院中心3年内收治的DKA成年患者进行了回顾性分析。根据糖尿病类型和种族将患者分为不同队列。使用统计方法对各队列进行描述和比较。我们记录了168例患者中的219例DKA病例，其中97%为非裔美国人或西班牙裔。53例（32%）患者患有T2DM。新发糖尿病在T2DM患者（P <.0001）和非裔美国人（P =.008）中更为常见，42例（25%）患者出现新发糖尿病。1型糖尿病（T1DM）的西班牙裔患者再次因DKA入院更为常见（P =.0001）。T2DM在非裔美国人中更为普遍（P =.04）。T1DM患者的酸中毒比T2DM患者更严重（pH值和碳酸氢盐更低，阴离子间隙更大；分别为P =.03、.02和.005）。T2DM患者的肌酐水平更高（P =.04），且更不太可能有明确的诱发原因（P =.02）。新发糖尿病患者的糖化血红蛋白A1c水平更高（P <.05），但T1DM和T2DM患者之间没有差异。死亡率为2%，仅发生在患有T2DM的非裔美国人中。我们得出结论，DKA是T2DM初始表现的一种重要方式，新发T2DM约占所有DKA新病例的60%。与西班牙裔患者相比，患有T2DM的非裔美国患者更容易发生DKA。T2DM患者可能在没有任何明确诱发因素的情况下发生糖尿病酮症酸中毒。DKA发病率的上升可能归因于其在T2DM中发生率的增加；因此，旨在一级预防T2DM的措施是值得的。
