Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
Programa de Pós-graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
Arch Endocrinol Metab. 2022 Jun 3;66(3):355-361. doi: 10.20945/2359-3997000000480. Epub 2022 Jun 2.
To evaluate the precipitating factors of diabetic ketoacidosis (DKA) in patients with type 1 diabetes hospitalized through the emergency department of a tertiary hospital.
Individuals with type 1 diabetes hospitalized for DKA from January 2005 to March 2010 (first period [P1], n = 75) and from April 2010 to January 2017 (second period [P2], n = 97) were identified through a query of electronic medical records. Data were collected by reviewing medical records. Only the first hospitalization of each participant in each period was included.
In P2, 44 patients (45.4%) were women, mean age was 26.2 ± 14.5 years, and 74 patients (76.3%) had a previous diagnosis of type 1 diabetes. Only 1 patient had glycated haemoglobin (HbA1c) below 64 mmol/mol (8.0%). Most patients (62.2%) had had a previous episode of DKA. In P1, non-adherence was the main cause of DKA (38.7%), followed by infection (24.0%). In P2, these rates were 34.0% and 24.7%, respectively; no statistical difference was observed between the two study periods (p = 0.790).
Over time, non-adherence remained the main precipitating factor of DKA, followed by infection, and no significant difference was observed between the two study periods. Elevated HbA1c, outside the therapeutic range, indicates suboptimal diabetes care and may explain, at least in part, poor adherence as a precipitating factor of decompensation. Health strategies, such as improved self-management of type 1 diabetes, may contribute to a future reduction in DKA episodes.
通过对一家三级医院急诊科收治的 1 型糖尿病患者进行研究，评估糖尿病酮症酸中毒（DKA）的诱发因素。
通过电子病历查询，确定了 2005 年 1 月至 2010 年 3 月（第一阶段[P1]，n = 75）和 2010 年 4 月至 2017 年 1 月（第二阶段[P2]，n = 97）期间因 DKA 住院的 1 型糖尿病患者。通过查阅病历收集数据。每个阶段每个患者仅纳入首次住院。
在 P2 中，44 名患者（45.4%）为女性，平均年龄为 26.2 ± 14.5 岁，74 名患者（76.3%）有 1 型糖尿病的既往诊断。只有 1 名患者糖化血红蛋白（HbA1c）低于 64 mmol/mol（8.0%）。大多数患者（62.2%）有过 DKA 发作史。在 P1 中，不遵医嘱是 DKA 的主要原因（38.7%），其次是感染（24.0%）。在 P2 中，这两个原因的比例分别为 34.0%和 24.7%；两个研究期间没有观察到统计学差异（p = 0.790）。
随着时间的推移，不遵医嘱仍然是 DKA 的主要诱发因素，其次是感染，两个研究期间没有观察到统计学差异。HbA1c 升高，超出治疗范围，表明糖尿病控制不佳，这至少可以部分解释不遵医嘱作为病情恶化的诱发因素。改善 1 型糖尿病的自我管理等健康策略，可能有助于未来减少 DKA 发作。
