Diabetic ketosis during hyperglycemic crisis is associated with decreased all-cause mortality in patients with type 2
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ORIGINAL ARTICLE
Diabetic ketosis during hyperglycemic crisis is associated with decreased all-cause mortality in patients with type 2 diabetes mellitus Ivan Kruljac1 Miroslav Ćaćić1 Petra Ćaćić2 Vedran Ostojić3 Mario Štefanović4 Aljoša Šikić5 Milan Vrkljan1 ●
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Received: 3 July 2016 / Accepted: 8 August 2016 © Springer Science+Business Media New York 2016
Abstract Patients with type 2 diabetes mellitus have impaired ketogenesis due to high serum insulin and low growth hormone levels. Evidence exists that ketone bodies might improve kidney and cardiac function. In theory, improved ketogenesis in diabetics may have positive effects. We aimed to assess the impact of diabetic ketosis on all-cause mortality in patients with type 2 diabetes mellitus presenting with hyperglycemic crisis. We analyzed 486 patients with diabetic ketosis and 486 age and sex-matched patients with non-ketotic hyperglycemia presenting to the emergency department. Cox proportional hazard models were used to analyze the link between patient characteristics and mortality. During an observation time of 33.4 months, death of any cause occurred in 40.9 % of the non-ketotic hyperglycemia group and 30.2 % of the DK group (hazard ratio in the diabetic ketosis group, 0.63; 95 % confidence interval 0.48–0.82; P = 0.0005). Patients with diabetic ketosis had a lower incidence of symptomatic heart failure and had improved renal function. They used less furosemide
* Ivan Kruljac [email protected] 1
Department of Endocrinology, Diabetes and Metabolic Diseases “Mladen Sekso”, University Hospital Center “Sestre Milosrdnice”, University of Zagreb School of Medicine, Vinogradska cesta 29, Zagreb 10000, Croatia
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University of Zagreb School of Medicine, Zagreb, Croatia
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Department of Internal Medicine, University Hospital “Sveti Duh”, Zagreb, Croatia
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Clinical Institute of Chemistry, University Hospital Center “Sestre Milosrdnice”, University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
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Department of Emergency Medicine, University Hospital Center “Sestre Milosrdnice”, Zagreb, Croatia
and antihypertensive drugs, more metformin and lower insulin doses, all of which was independently associated with decreased mortality. Plasma glucose and glycated hemoglobin levels were similar in both groups. Patients with hyperglycemic crisis and diabetic ketosis have decreased all-cause mortality when compared to those with non-ketotic hyperglycemia. diabetic ketosis might be a compensatory mechanism rather than a complication in patients with hyperglycemic crises, but further prospective studies are warranted. Keywords Type 2 diabetes mellitus Ketosis Ketogenesis Mortality Heart failure Kidney disease ●
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Introduction Type 2 diabetes mellitus (T2DM) is associated with impaired ketogenesis [1]. Even non-diabetic obese subjects tend to have lower serum non-esterified fatty acids and ketone bodies [2]. Hyperinsulinemia seems to directly suppress ketogenesis in the liver, but growth hormone and glucagon may have an important
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