Department of Endocrinology, Hamad General Hospital, Hamad Medical Corporation, 3050, Doha, Qatar.
Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO, USA.
BMC Endocr Disord. 2023 Sep 12;23(1):193. doi: 10.1186/s12902-023-01446-8.
Diabetic ketoacidosis (DKA) was once known to be specific to type-1 diabetes-mellitus (T1D); however, many cases are now seen in patients with type-2 diabetes-mellitus (T2D). Little is known about how this etiology shift affects DKA's outcomes.
We studied consecutive index DKA admissions from January 2015 to March 2021. Descriptive analyses were performed based on pre-existing T1D and T2D (PT1D and PT2D, respectively) and newly diagnosed T1D and T2D (NT1D and NT2D, respectively).
Of the 922 patients, 480 (52%) had T1D, of which 69% had PT1D and 31% NT1D, whereas 442 (48%) had T2D, of which 60% had PT2D and 40% NT2D. The mean age was highest in PT2D (47.6 ± 13.1 years) and lowest in PT1D (27.3 ± 0.5 years) (P < 0.001). Patients in all groups were predominantly male except in the PT1D group (55% females) (P < 0.001). Most patients were Arabic (76% in PT1D, 51.4% in NT1D, 46.6% in PT2D) except for NT2D, which mainly comprised Asians (53%) (P < 0.001). Patients with NT2D had the longest hospital length of stay (LOS) (6.8 ± 11.3 days) (P < 0.001), longest DKA duration (26.6 ± 21.1 h) (P < 0.001), and more intensive-care unit (ICU) admissions (31.2%) (P < 0.001). Patients with PT1D had the shortest LOS (2.5 ± 3.5 days) (P < 0.001), DKA duration (18.9 ± 4.2 h) (P < 0.001), and lowest ICU admissions (16.6%) (P < 0.001).
CONCLUSIONS/INTERPRETATION: We presented the largest regional data on differences in DKA based on the type and duration of diabetes- mellitus (DM), showing that T2D is becoming an increasing cause of DKA, with worse clinical outcomes (especially newly diagnosed T2D) compared to T1D.
糖尿病酮症酸中毒（DKA）曾被认为是 1 型糖尿病（T1D）特有的疾病；然而，现在许多病例发生在 2 型糖尿病（T2D）患者中。人们对这种病因转变如何影响 DKA 的结果知之甚少。
我们研究了 2015 年 1 月至 2021 年 3 月连续的 DKA 指数入院患者。根据现有的 1 型糖尿病（PT1D 和 T2D，分别）和新诊断的 1 型糖尿病和 2 型糖尿病（NT1D 和 NT2D，分别）进行描述性分析。
在 922 名患者中，480 名（52%）患有 T1D，其中 69%为 PT1D，31%为 NT1D，442 名（48%）患有 T2D，其中 60%为 PT2D，40%为 NT2D。PT2D 患者的平均年龄最高（47.6±13.1 岁），PT1D 患者的平均年龄最低（27.3±0.5 岁）（P<0.001）。除了 PT1D 组（55%为女性）（P<0.001），所有组的患者均以男性为主。大多数患者为阿拉伯人（PT1D 中为 76%，NT1D 中为 51.4%，PT2D 中为 46.6%），除了 NT2D，其主要由亚洲人组成（53%）（P<0.001）。NT2D 患者的住院时间最长（6.8±11.3 天）（P<0.001），DKA 持续时间最长（26.6±21.1 小时）（P<0.001），且 ICU 入院率最高（31.2%）（P<0.001）。PT1D 患者的住院时间最短（2.5±3.5 天）（P<0.001），DKA 持续时间最短（18.9±4.2 小时）（P<0.001），ICU 入院率最低（16.6%）（P<0.001）。
结论/解释：我们提供了基于糖尿病（DM）类型和持续时间的 DKA 差异的最大区域性数据，表明 T2D 成为 DKA 的一个日益增加的原因，与 T1D 相比，其临床结局更差（尤其是新诊断的 T2D）。
