Warner E A, Greene G S, Buchsbaum M S, Cooper D S, Robinson B E
Division of General Internal Medicine, University of South Florida College of Medicine, Tampa 33612, USA.
Arch Intern Med. 1998 Sep 14;158(16):1799-802. doi: 10.1001/archinte.158.16.1799.
Multiple risk factors for diabetic ketoacidosis (DKA) have been described, including omission of insulin therapy and clinical conditions known to increase counterregulatory hormones. Recently, substance abuse has been identified in patients with DKA. We observed many cases of DKA in cocaine users, although the association between cocaine use and DKA has not been well described in the medical literature.
We performed a retrospective case-control study of admissions for DKA in cocaine users and non-user controls in an urban teaching hospital from January 1, 1985, to December 31, 1994.
We identified 720 adult admissions for DKA. Twenty-seven cocaine users accounted for 102 admissions (14% of all DKA admissions). The users were compared with 85 nonuser controls who had 154 DKA admissions. Cocaine users had more admissions for DKA (mean, 3.78 vs 1.81; P = .03). Cocaine users were less likely than controls to have an intercurrent illness identified as a precipitating factor for DKA (14.7% vs 33.1%; P<.001) and were more likely to have missed taking insulin prior to admission (45.1% vs 24.7%; P<.001). Although cocaine users had higher serum glucose levels on admission (32.9 mmol/L [593.4 mg/dL] vs 29.5 mmol/L [531.1 mg/dL]; P =.03), no differences in intensity of illness or treatment outcome were detected.
In this preliminary study, cocaine use was found in a significant number of adults admitted with DKA and was associated with more frequent omission of insulin therapy and the absence of precipitating systemic illness. Either because of its association with insulin therapy omission or its effects on counterregulatory hormones, cocaine use should be considered a risk factor for DKA, particularly in patients with multiple admissions.
已描述了糖尿病酮症酸中毒（DKA）的多种危险因素，包括胰岛素治疗中断以及已知会增加对抗调节激素的临床状况。最近，在DKA患者中发现了药物滥用情况。我们观察到许多可卡因使用者发生DKA的病例，尽管医学文献中对可卡因使用与DKA之间的关联描述不多。
我们对1985年1月1日至1994年12月31日期间一家城市教学医院中因DKA入院的可卡因使用者和非使用者对照进行了一项回顾性病例对照研究。
我们确定了720例成人DKA入院病例。27名可卡因使用者占102例入院病例（占所有DKA入院病例的14%）。将这些使用者与85名有154例DKA入院病例的非使用者对照进行比较。可卡因使用者因DKA入院的次数更多（平均3.78次对1.81次；P = 0.03）。与对照相比，可卡因使用者被确定为DKA促发因素的并发疾病较少（14.7%对33.1%；P<0.001），且入院前未注射胰岛素的可能性更大（45.1%对24.7%；P<0.001）。尽管可卡因使用者入院时血糖水平较高（32.9 mmol/L [593.4 mg/dL]对29.5 mmol/L [531.1 mg/dL]；P = 0.03），但在疾病严重程度或治疗结果方面未发现差异。
在这项初步研究中，发现大量因DKA入院的成人使用可卡因，且与胰岛素治疗中断更频繁以及无促发全身性疾病有关。由于其与胰岛素治疗中断的关联或对对抗调节激素的影响，可卡因使用应被视为DKA的一个危险因素，尤其是在多次入院的患者中。
