Division of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, 610041, PR China.
Diabetes Res Clin Pract. 2012 Aug;97(2):306-12. doi: 10.1016/j.diabres.2012.05.004. Epub 2012 Jun 15.
To investigate the diabetic ketoacidosis (DKA) episodes occurred in diabetic adults and adolescents.
We reviewed diabetic patients of admissions with DKA in West China Hospital in Chengdu from January 1, 2008 to December 31, 2008. Clinical and laboratory data including β-cell function and autoantibody status were collected respectively. Patients were classified as having type 1 or type 2 diabetes or atypical diabetes based on clinical diagnosis and treatment history. And groups were compared for differences in vital statistics and biochemical profiles at presentation.
Detailed and accurate information was obtained in relation to 263 of patients accounted for the 287 admissions admitted for DKA, of whom 41 patients had type 1 diabetes (15.59%) meanwhile 178 patients were diagnosis as T2DM (67.68%), and 37 patients could not be "typed" were classified as atypical DM (14.07%). In addition, there were two gestational diabetes mellitus (GDM) and five patients with other specific types. Sixty admissions (22.81%) were newly diagnosed diabetes, of which 28 admissions (46.67%) were atypical diabetes. The most common contributing factor for DKA was infection (39.16%), followed by noncompliance with anti-diabetes treatment including omission of insulin (25.5%), unknown causes (25.86%) and other medical conditions (11.73%). Of note, these middle-age obese male patients with atypical diabetes often lapse into diabetic ketoacidosis without identifiable precipitating factors.
DKA could occur not only in T1DM but also in patients with T2DM under infection or stress condition, furthermore without any identifiable precipitant. The prevalence of DKA and its clinical heterogeneity have significant implications for diagnosing and classification of diabetes. More attention and prevention strategies are needed in ketosis-prone atypical diabetes.
研究成年和青少年糖尿病患者发生的糖尿病酮症酸中毒（DKA）发作情况。
我们回顾了 2008 年 1 月 1 日至 2008 年 12 月 31 日期间在华西医院住院的伴有 DKA 的糖尿病患者。分别收集了包括β细胞功能和自身抗体状态在内的临床和实验室数据。根据临床诊断和治疗史，将患者分为 1 型或 2 型糖尿病或非典型糖尿病。并对入院时的生命体征和生化特征进行了组间比较。
详细准确的信息与 263 名患者有关，占 287 名因 DKA 住院的患者，其中 41 名患者患有 1 型糖尿病（15.59%），178 名患者被诊断为 2 型糖尿病（67.68%），37 名无法“定型”的患者被归类为非典型糖尿病（14.07%）。此外，还有 2 名妊娠期糖尿病（GDM）和 5 名其他特殊类型的患者。60 例（22.81%）为新诊断的糖尿病，其中 28 例（46.67%）为非典型糖尿病。DKA 最常见的诱发因素是感染（39.16%），其次是不遵守抗糖尿病治疗，包括漏用胰岛素（25.5%）、原因不明（25.86%）和其他医疗条件（11.73%）。值得注意的是，这些中年肥胖男性非典型糖尿病患者常在无明显诱发因素的情况下发生糖尿病酮症酸中毒。
DKA 不仅可发生于 1 型糖尿病患者，也可发生于感染或应激状态下的 2 型糖尿病患者，且无明显诱因。DKA 的流行及其临床异质性对糖尿病的诊断和分类具有重要意义。需要对易发生酮症的非典型糖尿病给予更多关注和预防策略。
