1
|
Saadeh NA, Hammouri HM, Zahran DJ. Diabetic Ketoacidosis in Northern Jordan: Seasonal Morbidity and Characteristics of Patients. Diabetes Metab Syndr Obes 2023; 16:3057-3064. [PMID: 37810572 PMCID: PMC10559898 DOI: 10.2147/dmso.s413405] [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: 04/07/2023] [Accepted: 09/10/2023] [Indexed: 10/10/2023] Open
Abstract
Purpose This study aimed to characterize adult patients admitted with diabetic ketoacidosis (DKA) in northern Jordan. Methods The study examined medical records of patients diagnosed with DKA from January 2015 to April 2018. Variables analyzed included diabetes type, precipitating illness, admission month, hospital length of stay, and biochemical markers. Results Out of 232 admissions with DKA, 70% were diagnosed with type 2 diabetes, and 56% were females. 12% of admissions had a new diagnosis of diabetes, of which 51% had type 2 diabetes. Sepsis (48%), Non-adherence (26%), and diabetic foot infections (18%) were the most encountered precipitating factors for DKA in T1DM. As for T2DM, sepsis (52%), acute coronary syndrome (12%), and pancreatitis (8%) were the most precipitating factors for DKA. High urea levels, high creatinine levels, low phosphorous levels, low hemoglobin levels, and high platelet counts were associated with a longer hospital stay for type 1 diabetes. For type 2 diabetes, low pH on admission, old age, and high Hb A1c within 6 months of admission were factors associated with a prolonged hospital stay. The study found a significant peak of admissions for DKA in both type 1 and type 2 patients in the winter and spring months (Pearson P-value= 0.0013). Conclusion The results of the present study highlight the seasonal variation in the frequency of DKA hospitalizations. It also highlights sepsis as the most frequent precipitating factor of DKA in both type 1 and type 2 DM patients.
Collapse
Affiliation(s)
- Nesreen A Saadeh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Hanan M Hammouri
- Department of Mathematics and Statistics, Jordan University of Science and Technology, Irbid, Jordan
| | - Deeb J Zahran
- St. James’s University Hospital, Infectious Diseases Department, Leeds, UK
| |
Collapse
|
2
|
Jeon JY, Kim SK, Kim KS, Song SO, Yun JS, Kim BY, Kim CH, Park SO, Hong S, Seo DH, Seo JA, Noh JH, Kim DJ. Clinical characteristics of diabetic ketoacidosis in users and non-users of SGLT2 inhibitors. DIABETES & METABOLISM 2019; 45:453-457. [PMID: 30639566 DOI: 10.1016/j.diabet.2019.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/18/2018] [Indexed: 12/16/2022]
Abstract
AIM This study investigated the clinical characteristics of diabetic ketoacidosis (DKA) and compared the DKA characteristics between patients treated with and without SGLT2 inhibitors. METHODS Data were collected from patients aged ≥ 18 years admitted for DKA at nine centres in Korea between September 2014 and April 2017. The electronic medical records of these subjects were retrospectively reviewed. Based on their history of medications taken before admission, subjects were classified as either users or non-users of SGLT2 inhibitors and their clinical characteristics of DKA were compared. RESULTS During the study, the main subtype of DKA episodes (n = 523) was identified as type 2 diabetes (51%). Average hospitalization duration was 11 days, and average intensive care unit (ICU) time was 2.5 days. The in-hospital mortality rate was 3%, but no users of SGLT2 inhibitors died during DKA treatment. In patients taking SGLT2 inhibitors (n = 15), DKA manifested at 124 days, on average, after starting the inhibitors (range: 7-380 days). Also, SGLT2 inhibitors users had significantly lower plasma glucose levels (413 mg/dL) compared with non-users (554 mg/dL), and longer ICU stays (4 vs. 2 days; P = 0.019). CONCLUSION In this report of recent data on the clinical features of DKA in Korea, patients using SGLT2 inhibitors needed longer treatment in ICUs compared with non-users and had lower levels of blood glucose, whereas DKA associated with SGLT2 inhibitors was rare.
Collapse
Affiliation(s)
- J Y Jeon
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea
| | - S-K Kim
- Department of Internal Medicine, CHA Bundang Medical Centre, CHA University, Seongnam, Republic of Korea
| | - K-S Kim
- Department of Internal Medicine, CHA Bundang Medical Centre, CHA University, Seongnam, Republic of Korea
| | - S O Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - J-S Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - B-Y Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - C-H Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - S O Park
- Department of Internal Medicine, Gwangmyeong Sungae Hospital, Gwangmyeong, Republic of Korea
| | - S Hong
- Division of Endocrinology and Metabolism, Department of Internal medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - D H Seo
- Division of Endocrinology and Metabolism, Department of Internal medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - J A Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Ansan, Republic of Korea
| | - J H Noh
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - D J Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea.
| | | |
Collapse
|
3
|
Butalia S, Johnson JA, Ghali WA, Southern DA, Rabi DM. Temporal variation of diabetic ketoacidosis and hypoglycemia in adults with type 1 diabetes: A nationwide cohort study. J Diabetes 2016; 8:552-8. [PMID: 26301804 DOI: 10.1111/1753-0407.12336] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/16/2015] [Accepted: 08/19/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Seasonality in health outcomes has long been recognized for conditions such as colds and flus. The aim of the present study was to determine whether hospitalizations for acute complications of type 1 diabetes (T1D) vary by month and season. METHODS An observational study was performed of national administrative health data. Hospitalizations for acute complications in adults (aged ≥18 years) with T1D were identified using ICD-10 (Canadian revision) codes between 2004 and 2010. Monthly and seasonal counts per year were determined for the study period. For each acute complication, the ratio of the number of observed hospitalizations/expected number of hospitalizations was calculated for each month and season per year, adjusting for varied lengths of month, season, and year. RESULTS In all, there were 21 568 hospitalizations for diabetic ketoacidosis (DKA) and 5349 hospitalizations for hypoglycemia during the study period. December had higher than expected hospitalizations for DKA and March had higher than expected hospitalizations for hypoglycemia. There did not appear to be variation for either DKA or hypoglycemia hospitalizations by season. CONCLUSIONS The results of the present study suggest temporal variation in hospitalizations for DKA and hypoglycemia, and therefore signal important times of patient vulnerability. Potential mechanisms underlying this pattern warrant further examination. Prevention strategies and resources for patients with T1D may need to be increased at specific times during the year.
Collapse
Affiliation(s)
| | | | - William A Ghali
- Cardiac Sciences, Faculty of Medicine, University of Calgary, Calgary
| | | | - Doreen M Rabi
- Cardiac Sciences, Faculty of Medicine, University of Calgary, Calgary
- Department of Public Health Sciences, University of Alberta, Edmonton, Canada
| |
Collapse
|
4
|
Siwakoti K, Panthi S, Pathak R, Kadaria D. Seasonal variation in hospitalizations for diabetic ketoacidosis in the U.S.: Insights from the Nationwide Inpatient Sample. J Diabetes 2016; 8:443-4. [PMID: 26694201 DOI: 10.1111/1753-0407.12369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/07/2016] [Accepted: 12/15/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Krishmita Siwakoti
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sagar Panthi
- Department of Medicine, Institute of Medicine, Kathmandu, Nepal
| | - Ranjan Pathak
- Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania, USA
| | - Dipen Kadaria
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| |
Collapse
|
5
|
Song SO, Song YD, Nam JY, Park KH, Yoon JH, Son KM, Ko Y, Lim DH. Epidemiology of Type 1 Diabetes Mellitus in Korea through an Investigation of the National Registration Project of Type 1 Diabetes for the Reimbursement of Glucometer Strips with Additional Analyses Using Claims Data. Diabetes Metab J 2016; 40:35-45. [PMID: 26912154 PMCID: PMC4768049 DOI: 10.4093/dmj.2016.40.1.35] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/29/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this study was to estimate the prevalence and incidence of type 1 diabetes mellitus (T1DM) in Korea. In addition, we planned to do a performance analysis of the Registration Project of Type 1 diabetes for the reimbursement of consumable materials. METHODS To obtain nationwide data on the incidence and prevalence of T1DM, we extracted claims data from July 2011 to August 2013 from the Registration Project of Type 1 diabetes on the reimbursement of consumable materials in the National Health Insurance (NHI) Database. For a more detailed analysis of the T1DM population in Korea, stratification by gender, age, and area was performed, and prevalence and incidence were calculated. RESULTS Of the 8,256 subjects enrolled over the 26 months, the male to female ratio was 1 to 1.12, the median age was 37.1 years, and an average of 136 new T1DM patients were registered to the T1DM registry each month, resulting in 1,632 newly diagnosed T1DM patients each year. We found that the incidence rate of new T1DM cases was 3.28 per 100,000 people. The average proportion of T1DM patients compared with each region's population was 0.0125%. The total number of insurance subscribers under the universal compulsory NHI in Korea was 49,662,097, and the total number of diabetes patients, excluding duplication, was 3,762,332. CONCLUSION The prevalence of T1DM over the course of the study was approximately 0.017% to 0.021% of the entire population of Korea, and the annual incidence of T1DM was 3.28:100,000 overall and 3.25:100,000 for Koreans under 20 years old.
Collapse
Affiliation(s)
- Sun Ok Song
- Department of Endocrinology and Metabolism, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Young Duk Song
- Department of Endocrinology and Metabolism, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
| | - Joo Young Nam
- Department of Endocrinology and Metabolism, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Kyeong Hye Park
- Department of Endocrinology and Metabolism, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Ji Hae Yoon
- National Health Insurance Service, Seoul, Korea
| | | | - Young Ko
- National Health Insurance Service, Seoul, Korea
| | - Dong Ha Lim
- National Health Insurance Service, Seoul, Korea
| |
Collapse
|
6
|
Weinert LS, Scheffel RS, Severo MD, Cioffi AP, Teló GH, Boschi A, Schaan BD. Precipitating factors of diabetic ketoacidosis at a public hospital in a middle-income country. Diabetes Res Clin Pract 2012; 96:29-34. [PMID: 22153415 DOI: 10.1016/j.diabres.2011.11.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/30/2011] [Accepted: 11/07/2011] [Indexed: 12/17/2022]
Abstract
AIMS To study precipitating factors of diabetic ketoacidosis (DKA) at a public hospital in a middle-income country. METHODS Eighty patients with type 1 diabetes who had an emergency hospitalization for DKA between January 2005 and March 2010 at a tertiary care teaching hospital in Southern Brazil were studied. Data were collected by reviewing medical records and telephone calls. Treatment non-adherence was defined as the precipitating factor if there was diet abuse or insulin therapy noncompliance without identifiable infection. RESULTS The mean age of patients was 26±13 years. The majority (91.5%) of the patients had unsatisfactory metabolic control before the hospitalization. The most common DKA precipitating factor was treatment non-adherence: 39% of cases when all patients were evaluated and 49% when only patients with previous type 1 diabetes diagnosis were analyzed. Comparison between patients with DKA precipitated by treatment non-adherence and by other causes showed that the former group had more episodes of previous DKA and more frequently reported insulin omission previous to DKA. CONCLUSIONS Treatment noncompliance is the leading precipitating factor of DKA in Southern Brazil. Further efforts to reduce the occurrence of DKA should focus on patients with prior reports and evidence of treatment non-adherence.
Collapse
Affiliation(s)
- Letícia S Weinert
- Postgraduate Program-Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2150, Porto Alegre, Brazil.
| | | | | | | | | | | | | |
Collapse
|
7
|
Lee JI, Sohn TS, Chang SA, Lee JM, Cha BY, Son HY, Son HS. Clinical Characteristics and Outcomes of Diabetic Ketoacidosis at a Single Institution. KOREAN DIABETES JOURNAL 2008. [DOI: 10.4093/kdj.2008.32.2.165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Jee In Lee
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Korea
| | - Tae Seo Sohn
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Korea
| | - Sang Ah Chang
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Korea
| | - Jung Min Lee
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Korea
| | - Bong Yun Cha
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Korea
| | - Ho Young Son
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Korea
| | - Hyun Shik Son
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Korea
| |
Collapse
|
8
|
Affiliation(s)
- Kyu Jeung Ahn
- Department of Internal Medicine, Eulji University College of Medicine & Hospital, Korea.
| |
Collapse
|
9
|
Park Y, Lee H, Koh CS, Min H, Zimmet PZ, Rowley MJ, Mackay IR, Trucco M, Dorman JS. Low prevalence of immunogenetic markers of IDDM in adult Koreans with diabetes detected on OGTT. Diabetes Res Clin Pract 1996; 34 Suppl:S37-43. [PMID: 9015668 DOI: 10.1016/s0168-8227(96)90006-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In the Asian populations, it is not uncommon for adult patients with NIDDM to eventually lose beta-cell function and develop IDDM. Accepting that IDDM is an autoimmune disease, which occurs on a genetic background, it could by hypothesized that by measuring autoantibody prevalence and HLA DQ gene polymorphism, known important prediagnostic markers of IDDM, the prevalence of adult-onset IDDM in patients with previously undiagnosed NIDDM patients could be estimated. To do this, anti-GAD prevalence and HLA DQ A1 and DQ B1 polymorphisms after PCR amplification of genomic DNA were analyzed in 121 newly diagnosed diabetic patients of Yonchon cohort and compared to the results with those of 100 matched health control subjects. We also compared the results with those of other populations to assess the difference of genotype distribution. The overall prevalence of anti-GAD antibodies was 1.7% (2 of 121) in patients with previously undiagnosed NIDDM, whereas 1 of 100 controls had positive antibodies. Among those who were positive, their titer of antibodies to GAD were not high. No statistically significant differences in the distribution of either mean levels of anti-GAD or DQA1 and DQB1 alleles were found comparing NIDDM patients to controls. Interestingly, the frequency of DQB1*non-Asp-57 and DQA1*Arg-52 alleles in the Korean adult control population was similar to that of US Caucasians (DQB1*non-Asp-57: 0.431 vs. 0.475; DQA1*Arg-52: 0.492 vs. 0.463). The low prevalence of anti-GAD antibodies and HLA-DQA1 and DQB1 susceptibility alleles among recent-onset NIDDM patients, not different compared to controls suggests that diabetes in Korean adults is unlikely to have an autoimmune component to its pathogenesis.
Collapse
Affiliation(s)
- Y Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|