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Dragila Ž, Ćosić K, Grubešić I, Čalošević S, Šolić K, Bačun T. PRECIPITATING FACTORS AND SYMPTOMS IN PATIENTS WITH DIABETIC KETOACIDOSIS. Acta Clin Croat 2023; 62:65-74. [PMID: 38304369 PMCID: PMC10829968 DOI: 10.20471/acc.2023.62.01.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Indexed: 02/03/2024] Open
Abstract
The aim of the study was to determine the most common precipitating factors and symptoms of diabetic ketoacidosis and the possible difference according to age, gender and severity of diabetic ketoacidosis. Medical records from January 1, 2017 until December 31, 2019 were reviewed and patients diagnosed with diabetic ketoacidosis were selected. The study included 52 patients, median age 34 (interquartile range 21-56) years. There was no statistically significant difference between male and female gender. The severity of diabetic ketoacidosis was moderate in the majority of cases (65.4%; p=0.005). The most common precipitating factor was infection (61.7%). In patients with moderate diabetic ketoacidosis, respiratory infections were more common, while gastrointestinal infections were more common in severe diabetic ketoacidosis (33% and 25%, respectively; p=0.03). Nausea (median age 32 years; p=0.004) and vomiting (median age 31 years; p=0.01) were more common in younger age groups, while altered mental status was more common in the older age group (median age 61 years; p=0.001). Infection was the most common precipitating factor. The most common symptoms in younger age groups were nausea and vomiting, and altered mental status in the older age group.
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Affiliation(s)
- Željka Dragila
- Osijek Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Klara Ćosić
- Osijek Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Ivana Grubešić
- Osijek Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Srđan Čalošević
- Emergency Medical Center of the Osijek-Baranja County, Osijek, Croatia
| | - Krešimir Šolić
- Osijek Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Osijek Faculty of Electrical Engineering, Computer Science and Information Technology, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Tatjana Bačun
- Osijek Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Division of Endocrinology, Department of Internal Medicine, Osijek University Hospital Center, Osijek, Croatia
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Anis TR, Boudreau M, Thornton T. Comparing the Efficacy of a Nurse-Driven and a Physician-Driven Diabetic Ketoacidosis (DKA) Treatment Protocol. Clin Pharmacol 2021; 13:197-202. [PMID: 34675693 PMCID: PMC8504870 DOI: 10.2147/cpaa.s334119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background Standardized DKA treatment could result in better overall safety and efficacy outcomes. The primary objective of this study is to validate the efficacy of an adapted nurse-driven DKA protocol compared to a physician-driven DKA protocol across the continuum of three hospital settings: the University of Colorado upon which the physician-driven protocol is based, Northern Light Eastern Maine Medical Center (NLEMMC), and Northern Light Sebasticook Valley Hospital (NLSVH). The secondary objective is to assess the safety of the adapted nurse-driven DKA protocol adapted at NLEMMC and NLSVH through determining the incidence of hypoglycemia and anion gap reopening. Patients and Methods This was a retrospective, IRB-approved, multi-center study that included: patients 18 years or older who were treated with the DKA protocol at NLEMMC or NLSVH, and admitted to the emergency department between July 2015 and October 2020 with a primary diagnosis of DKA and an elevated anion gap greater than or equal to 13 mEq/L. Results A total of 90 patients from NLEMMC and 64 patients from NLSVH were included and compared to 111 patients from the University of Colorado who were included in the post protocol implementation group. There was no statistically significant difference in the primary outcome, time to anion gap closure, between the original University of Colorado study (10.3 hours) and the NLEMMC (10.9 hours, p = 0.420) and NLSVH (8.8 hours, p = 0.115) results presented in this study. Conclusion The standardized nurse-driven DKA treatment protocol at NLEMMC and NLSVH showed no statistical difference in time to anion gap closure compared to the University of Colorado study upon which it was based. This finding is particularly relevant to hospitals such as NLEMMC and NLSVH that lack provider resources and teams of endocrinologists required for the physician-driven DKA protocol.
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Affiliation(s)
- Takla R Anis
- Pharmacy Department, Northern Light Eastern Maine Medical Center, Bangor, ME, USA
| | - Marybeth Boudreau
- Pharmacy Department, Northern Light Eastern Maine Medical Center, Bangor, ME, USA
| | - Tyson Thornton
- Pharmacy Department, Northern Light Sebasticook Valley Hospital, Pittsfield, ME, USA
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Vomiting and hyperkalemia are novel clues for emergency room diagnosis of type 1 diabetic ketoacidosis: a retrospective comparison between diabetes types. Diabetol Int 2021; 13:272-279. [DOI: 10.1007/s13340-021-00539-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
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Okada A, Yamana H, Morita K, Sato Y, Yamaguchi S, Kurakawa KI, Michihata N, Matsui H, Fushimi K, Nangaku M, Yamauchi T, Yasunaga H, Kadowaki T. Potassium Concentration in Initial Fluid Therapy and In-Hospital Mortality of Patients with Diabetic Ketoacidosis. J Clin Endocrinol Metab 2021; 106:e2162-e2175. [PMID: 33493293 DOI: 10.1210/clinem/dgab029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Guidelines worldwide recommend potassium replacement of 10 to 40 mmol/L in the initial fluid therapy for patients with diabetic ketoacidosis. However, evidence is lacking as to the association between infused potassium concentration and mortality. OBJECTIVE We aimed to determine the association between infused potassium concentration and in-hospital mortality. METHODS Using the Japanese Diagnosis Procedure Combination database, we retrospectively identified inpatients admitted for treatment of diabetic ketoacidosis from July 2010 to March 2018. Patients with kidney dysfunction or serum potassium abnormalities were excluded. We evaluated the association of the potassium concentration in the total infused solutions in the first 2 days of hospitalization with 28-day in-hospital mortality using multivariable regression analysis with a cubic spline model. We also assessed the association between potassium concentration and occurrence of hyperkalemia. RESULTS We identified 14 216 patients with diabetic ketoacidosis and observed 261 deaths. The quartile cut-points for potassium concentration were 7.7, 11.4, and 16.1 mmol/L. Within the range of approximately 10 to 40 mmol/L, potassium concentration was not associated with occurrence of hyperkalemia or death. Lower potassium concentrations were associated with higher 28-day in-hospital mortality; the odds ratio for patients receiving 8 mmol/L was 1.69 (95% CI, 1.03 to 2.78; reference: 20 mmol/L), and the odds ratio increased monotonically as potassium concentration decreased further. CONCLUSION Patients receiving potassium replacement at concentrations of 10 to 40 mmol/L had similar in-hospital mortality rates, whereas lower concentrations were associated with higher mortality.
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Affiliation(s)
- Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hayato Yamana
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kojiro Morita
- Department of Health Services Research, University of Tsukuba, Tsukuba, Japan
| | - Yukihito Sato
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
| | - Satoko Yamaguchi
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kayo Ikeda Kurakawa
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
| | - Takashi Kadowaki
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Toranomon Hospital, Tokyo, Japan
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Boeder S, Kulasa K. Hospital care: improving outcomes in type 1 diabetes. Curr Opin Endocrinol Diabetes Obes 2021; 28:14-20. [PMID: 33315629 DOI: 10.1097/med.0000000000000601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Caring for patients with type 1 diabetes (T1D) in the hospital presents unique challenges. This review provides an update on significant issues relevant to the inpatient management of T1D. Topics include trends in diabetic ketoacidosis (DKA), hypoglycemia, and adapting ambulatory technologies for inpatient use. RECENT FINDINGS Rates of DKA in the United States are rising. Although socioeconomic status, health insurance coverage, and hemoglobin A1c are persistently associated with DKA in individuals with T1D, newer risk factors have also emerged. These include the off-label use of sodium-glucose cotransporter inhibitor medications, immune checkpoint inhibitor-induced diabetes, and infection with severe acute respiratory syndrome coronavirus 2. Hypoglycemia is common among hospitalized patients with T1D. Use of validated hypoglycemia risk prediction models and multidisciplinary care initiatives can reduce the risk of inpatient hypoglycemia. Finally, continuous glucose monitoring is being adapted for use in the hospital setting and has shown promise during the coronavirus disease 2019 (COVID-19) pandemic. SUMMARY Evidence-based treatment algorithms, risk prediction calculators, multidisciplinary interventions, and wearable technology hold promise for improved outcomes in hospitalized patients with T1D.
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Affiliation(s)
- Schafer Boeder
- Department of Medicine, Division of Endocrinology and Metabolism, University of California, San Diego, La Jolla, California, USA
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Kidie AA, Lakew AM, Ayele T. Frequency of Diabetic Ketoacidosis and Its Determinants Among Pediatric Diabetes Mellitus Patients in Northwest Ethiopia. Diabetes Metab Syndr Obes 2021; 14:4819-4827. [PMID: 34984014 PMCID: PMC8699764 DOI: 10.2147/dmso.s326537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 12/04/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is one of the most common public health problems and is still a major child killer in sub-Saharan African countries, particularly Ethiopia. There are limited and inconclusive data in Amhara regional state; moreover, predictors for the incidence of DKA were not investigated before. Therefore, this study aimed to assess the frequency of DKA and its determinants among pediatric diabetes mellitus patients in public hospitals in northwest Ethiopia. METHODS An institutional-based retrospective follow-up study was conducted from September 2015 to February 2018 at selected public hospitals in northwest Ethiopia. A simple random sampling method was used to select 389 study subjects. Statistical analysis was done by R-studio version 1.1.4. Akakia's information criteria was used for model comparison and the negative binomial regression model was fitted to identify determinants for the frequency of DKA. An adjusted incidence rate ratio with 95% confidence interval was used to declare statistical significance. RESULTS The average frequency of DKA was 1.01 per individual. The incidence rate of DKA was increased among diabetes mellitus patients with an infection (adjusted incidence rate ratio (AIRR) = 1.41, 95% CI = 1.05-2.14), heart diseases (AIRR = 4.1, 95% CI = 1.17-14.68), treatment discontinuation (AIRR = 2.91, 95% CI = 2.02-4.22), low level of sodium (AIRR = 1.88, 95% CI = 1.22-2.89) and low dose of treatment at baseline (AIRR = 0.96, 95% CI = 0.94-0.97). CONCLUSION Having an infection, heart diseases, taking a low dose of treatment, a low sodium level, and treatment discontinuation were the factors that increase the frequency of DKA.
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Affiliation(s)
- Atitegeb Abera Kidie
- Department of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Ayenew Molla Lakew
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
- Correspondence: Ayenew Molla Lakew Email
| | - Tiruneh Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Redant S, De Bels D, Massaut J, Devriendt J, Beretta-Piccoli X, Attou R, Honore PM. Ketoacidosis in type 1 diabetics: we should return to pediatric guidelines. Ann Intensive Care 2020; 10:19. [PMID: 32048069 PMCID: PMC7013019 DOI: 10.1186/s13613-020-0639-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/04/2020] [Indexed: 11/17/2022] Open
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Negera GZ, Weldegebriel B, Fekadu G. Acute Complications of Diabetes and its Predictors among Adult Diabetic Patients at Jimma Medical Center, Southwest Ethiopia. Diabetes Metab Syndr Obes 2020; 13:1237-1242. [PMID: 32368116 PMCID: PMC7182448 DOI: 10.2147/dmso.s249163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/05/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is a group of metabolic disorders characterized by hyperglycemia resulting from impairment in insulin secretion, insulin action, or both. It is responsible for a wide range of acute and chronic complications. In this study, we aimed to assess acute complications of diabetes and its predictors among adult DM patients at Jimma Medical Center (JMC), southwest Ethiopia. METHODS A facility-based cross-sectional study involving 348 diabetic patients was conducted from February to May 31, 2019 at JMC. Logistic regression was conducted to identify predictors of acute complications of diabetes. Variables with P≤0.25 on bivariate logistic regression were considered candidates for multivariate regression. ORs and 95% CIs with P<0.05 were considered statistically significant. RESULTS Of the 348 patients, 225 (64.7%) were male, and the mean age of study participants was 46±15.5 years. Most (281, 80.7%) had type 2 DM. More than two-thirds (240, 69%)had diabetes duration of <5 years. During the study period, 92 (26.4%) patients developed acute complications of diabetes. Of these, 68 (73.9%) had diabetic ketoacidosis, 21 (22.8%) a hyperglycemic hyperosmolar state, and three (3.3%) hypoglycemia. Presence of comorbidity (AOR 5.6, 95% CI 2.80-11.19), type 1 DM (AOR 9.3, 95% CI 4.36-19.82), uncontrolled blood glucose (AOR 1.91, 95% CI 1.05-3.45), and lack of access to a health facility within a reasonable distance (AOR 1.96, 95% CI 1.11-3.45) were independent predictors of acute complications of diabetes. CONCLUSION The magnitude of acute complications among DM patients at JMC was high. Comorbidity, type 1 DM, uncontrolled blood sugar, and lack of access to a health facility within a reasonable distance were independent predictors of acute complications. Clinicians should follow up this subgroup of DM patients closely.
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Affiliation(s)
- Getandale Zeleke Negera
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Belachew Weldegebriel
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Ginenus Fekadu
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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