Multicentre analysis of hyperglycaemic hyperosmolar state and diabetic ketoacidosis in type 1 and type 2 diabetes
- PDF / 649,698 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 43 Downloads / 220 Views
ORIGINAL ARTICLE
Multicentre analysis of hyperglycaemic hyperosmolar state and diabetic ketoacidosis in type 1 and type 2 diabetes S. R. Tittel1,2 · K. M. Sondern3 · M. Weyer4 · T. Poeplau5 · B. M. Sauer6 · M. Schebek7 · K.‑H. Ludwig8 · F. Hammer9 · E. Fröhlich‑Reiterer10 · R. W. Holl1,2 · for the DPV Initiative Received: 12 December 2019 / Accepted: 18 April 2020 © The Author(s) 2020
Abstract Aims To compare diabetes patients with hyperglycaemic hyperosmolar state (HHS), diabetic ketoacidosis (DKA), and patients without decompensation (ND). Methods In total, 500,973 patients with type 1 or type 2 diabetes of all ages registered in the diabetes patient follow-up (DPV) were included. Analysis was stratified by age (≤ / > 20 years) and by manifestation/follow-up. Patients were categorized into three groups: HHS or DKA—during follow-up according to the most recent episode—or ND. Results At onset of diabetes, HHS criteria were met by 345 (68.4% T1D) and DKA by 9824 (97.6% T1D) patients. DKA patients had a lower BMI(-SDS) in both diabetes types compared to ND. HbA1c was higher in HHS/DKA. During follow-up, HHS occurred in 1451 (42.2% T1D) and DKA in 8389 patients (76.7% T1D). In paediatric T1D, HHS/DKA was associated with younger age, depression, and dyslipidemia. Pump usage was less frequent in DKA patients. In adult T1D/T2D subjects, metabolic control was worse in patients with HHS/DKA. HHS and DKA were also associated with excessive alcohol intake, dementia, stroke, chronic kidney disease, and depression. Conclusions HHS/DKA occurred mostly in T1D and younger patients. However, both also occurred in T2D, which is of great importance in the treatment of diabetes. Better education programmes are necessary to prevent decompensation and comorbidities. Keywords Hyperglycaemic hyperosmolar state · Diabetic ketoacidosis · Acute complication · Metabolic decompensation · Multicentre registry
Introduction Hyperglycaemic hyperosmolar state (HHS) and diabetic ketoacidosis (DKA) are life-threatening events for diabetes patients. According to the ISPAD guidelines [1], criteria for HHS include (1) plasma glucose concentration > 33.3 mmol/l, (2) arterial pH ≥ 7.3, (3) serum bicarbonate ≥ 15 mmol/l, (4) serum osmolality > 320 mOsm/kg, (5) decreased consciousness or seizures, (6) absent or mild Managed by Massimo Federici. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00592-020-01538-0) contains supplementary material, which is available to authorized users. * S. R. Tittel sascha.tittel@uni‑ulm.de Extended author information available on the last page of the article
ketonuria, (7) absent to mild ketonemia; criteria for DKA are (1) blood glucose concentration > 11 mmol/l, (2) pH 33.3 mmol/mol, if impaired consciousness was documented). Missing pH/bicarbonate values were assumed to be ≥ 7.3, ≥ 15 mmol/l, respectively, because these measurements are mostly taken in case of suspected decompensation. In case of HHS, we also allowed for diagnosis without pH/bicarbonate values if
Data Loading...
