What factors predict DKA in adults with T1D?

  • Kalscheuer H & al.
  • Diabetes Care
  • 17 ene. 2019

  • de Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Among adults with type 1 diabetes (T1D), factors increasing risk for diabetic ketoacidosis (DKA, serum pH

Why this matters

  • DKA is life-threatening, and rates have been rising.
  • DKA not well-studied among adults with T1D.

Study design

  • Registry data, 2000-2016, for 46,966 patients with T1D aged ≥18 years, onset at age ≥6 months, duration ≥1 year.
  • Adjustments for sex, age, diabetes duration, HbA1c, treatment regimen, diabetes center, migration status.
  • Funding: German Diabetes Society, German government, Boehringer Ingelheim Pharma GmbH & Co.

Key results

  • Overall, 2.5 DKA-related hospital admissions/100 patient-years.
  • Highest rates in patients aged 18-30 years (4.03/100 patient-years), declining with increasing age.
  • Patients with migrant background (patient or parents) had significantly higher hospitalization rates vs those without (3.40 vs 2.47 per 100 patient-years; P<.05>
  • Lower DKA rates with:
    • diabetes duration ≤2 years or >20 years (2.03 and 1.62 per 100 patient-years, respectively, vs 5-10 years); and
    • HbA1c
  • Patients ages 31-50 years on insulin pumps had lower DKA rates vs those having multiple daily injections (2.21 vs 3.12 per 100 patient-years; P<.05>

Limitations

  • Observational.
  • Possible reporting biases.