Modzelewski Katherine L, Rybin Denis V, Weinberg Janice M, Alexanian Sara M, McDonnell Marie E, Steenkamp Devin W
Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston University School of Medicine, 732 Harrison Avenue, 2nd Floor, MA 02118, United States.
Department of Biostatistics, School of Public Health, Boston University, 715 Albany St., Boston, MA 02118, United States.
J Clin Transl Endocrinol. 2017 Jun 1;9:1-7. doi: 10.1016/j.jcte.2017.05.004. eCollection 2017 Sep.
Hyperglycemic crisis encompasses a group of diabetes emergencies characterized by insulin deficiency with high morbidity and mortality. Cocaine use is increasingly prevalent in the United States and may be associated with increased risk of diabetic ketoacidosis. The objective was to determine if active cocaine use at hospital admission could be considered a risk factor for development of hyperglycemic crisis.
A retrospective case-control analysis was performed on 950 inpatients with hyperglycemia at an urban academic hospital. Patients admitted with non-emergent hyperglycemia were compared to patients who met criteria for diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), and hyperosmolar ketoacidosis (HK), based on the absence or presence of cocaine metabolites on urine toxicology screen. Outcomes included frequency of cocaine use in patients with DKA, HHS, HK, and non-emergent hyperglycemia; phenotypic characteristics of cocaine users vs. non-users with hyperglycemia; phenotypic characteristics of patients with hyperglycemic crisis vs. non-emergent hyperglycemia.
950 patients were admitted with hyperglycemia, 133 of which met criteria for hyperglycemic crisis. There was no significant difference in the frequency of cocaine use in individuals with non-emergent hyperglycemia compared to individuals with hyperglycemic crisis (16.9% vs. 17.2%, p = 0.90). 16.9% of patients with DKA, 16.4% of patients with HHS, and 6.4% of patients with HK were cocaine users.
We found no association between active cocaine use at the time of hospital admission and development of hyperglycemic crisis, when compared to non-emergent hyperglycemia. The role of routine screening for cocaine use in patients with hyperglycemic crisis is unclear.
高血糖危象是一组以胰岛素缺乏为特征的糖尿病急症，发病率和死亡率较高。在美国，可卡因的使用日益普遍，可能与糖尿病酮症酸中毒风险增加有关。目的是确定入院时正在使用可卡因是否可被视为发生高血糖危象的危险因素。
对一家城市学术医院的950例高血糖住院患者进行回顾性病例对照分析。根据尿液毒理学筛查中是否存在可卡因代谢物，将非紧急高血糖入院患者与符合糖尿病酮症酸中毒（DKA）、高渗高血糖状态（HHS）和高渗性酮症酸中毒（HK）标准的患者进行比较。结果包括DKA、HHS、HK和非紧急高血糖患者中可卡因使用的频率；可卡因使用者与高血糖非使用者的表型特征；高血糖危象患者与非紧急高血糖患者的表型特征。
950例患者因高血糖入院，其中133例符合高血糖危象标准。与高血糖危象患者相比，非紧急高血糖患者中可卡因使用频率无显著差异（16.9%对17.2%，p = 0.90）。DKA患者中有16.9%、HHS患者中有16.4%、HK患者中有6.4%是可卡因使用者。
与非紧急高血糖相比，我们发现入院时正在使用可卡因与高血糖危象的发生之间没有关联。对高血糖危象患者进行可卡因使用常规筛查的作用尚不清楚。
