Tapia Sanchiz Maria Sara, Navas Moreno Victor, Lopez Ruano Marta, Martínez Otero Carmen, Carrillo López Elena, Sager La Ganga Carolina, Raposo López Juan José, Amar Selma, González Castañar Sara, Arranz Martín Jose Alfonso, Marazuela Mónica, Sebastian-Valles Fernando
Servicio de Endocrinología y Nutrición, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid; Instituto de Investigación Sanitaria de La Princesa, Madrid, España.
Servicio de Endocrinología y Nutrición, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid; Instituto de Investigación Sanitaria de La Princesa, Madrid, España.
Med Clin (Barc). 2025 Jul;165(1):106973. doi: 10.1016/j.medcli.2025.106973. Epub 2025 May 15.
The aim of this study was to analyze the differences in diabetic ketoacidosis (DKA) between type 2 diabetes (T2D) and type 1 diabetes (T1D) in a Spanish cohort.
This retrospective cohort study included all cases of DKA between 2010 and 2024 in a Spanish tertiary hospital. Clinical and laboratory variables were collected to identify differences between DKA in T2D and T1D. Logistic regression models were used to evaluate 30-day mortality following a DKA event.
A total of 249 subjects (52.2% female) with a mean age of 50.2±19.9 years were included. Eighty-nine patients (35.7%) had T2D, and 160 (64.3%) had T1D. A higher proportion of cardiovascular precipitating events was observed in the T2D group (12.5% vs. 3.2%; P=.005), along with a more favorable blood gas profile, characterized by higher pH, bicarbonate levels, and lower ketone body concentrations (P<.05). However, 30-day mortality was 13.5% in T2D and 1.3% in T1D (P<.001). Logistic regression models identified cardiovascular events, lower Glasgow Coma Scale scores, and higher urea levels as predictors of mortality (P<.05), independent of age and diabetes type.
DKA in T2D is associated with a higher risk of mortality due to the severity of precipitating factors, despite a more favorable blood gas profile compared to T1D. Early identification of episodes is essential to prevent complications.
本研究旨在分析西班牙队列中2型糖尿病（T2D）和1型糖尿病（T1D）患者糖尿病酮症酸中毒（DKA）的差异。
这项回顾性队列研究纳入了西班牙一家三级医院2010年至2024年间所有DKA病例。收集临床和实验室变量以确定T2D和T1D患者DKA的差异。采用逻辑回归模型评估DKA事件后30天的死亡率。
共纳入249名受试者（52.2%为女性），平均年龄为50.2±19.9岁。89例患者（35.7%）患有T2D，160例（64.3%）患有T1D。T2D组心血管促发事件的比例更高（12.5%对3.2%；P = 0.005），同时血气指标更有利，表现为pH值、碳酸氢盐水平更高，酮体浓度更低（P < 0.05）。然而，T2D患者30天死亡率为13.5%，T1D患者为1.3%（P < 0.001）。逻辑回归模型确定心血管事件、较低的格拉斯哥昏迷量表评分和较高的尿素水平是死亡率的预测因素（P < 0.05），与年龄和糖尿病类型无关。
尽管与T1D相比，T2D患者的血气指标更有利，但由于促发因素的严重性，T2D患者发生DKA时的死亡风险更高。早期识别发作对于预防并发症至关重要。
