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Background: Diabetic ketoacidosis (DKA) remains an important cause of hospitalisation and death in people with diabetes mellitus (DM) living in low- and middle-income countries. The clinical profile of patients with DKA varies, and maybe contributory to the outcomes observed globally. The aim of this study was to describe the clinical characteristics of people with diabetic ketoacidosis (DKA) seen at a clinic in The Gambia during a one-and-a-half-year period. Methods: This was a retrospective chart review that included people with DM who were seen from June 2017 to December 2018 at the Medical Research Council the Gambia at London School of Hygiene and Tropical Medicine. Biodata, anthropometric and admissions data were extracted for all patients from the electronic medical records system. Data were analysed for differences in clinical and biochemical characteristics on admission for DKA. Results: In total, 23 out of 103 admissions for people with DM were for a diagnosis of DKA during the study period. Sixteen of those included were females and the mean age of all patients was 35 ± 13 years. Two people had type 1 DM and 15 people were categorised as type 2 DM. DM was diagnosed for the first time during admission for DKA for 12 people and 6 people had confirmed sepsis. There were no significant differences in age at diagnosis of DM or biochemical characteristics. Conclusion: DKA was a common indication for admission for people with DM in the Medical Research Council the Gambia at London School of Hygiene and Tropical Medicine and the majority of patients with DKA had type 2 DM. Further studies are needed to describe DKA in this setting more accurately.
Subject(s)
Prevalence , Retrospective Studies , Diabetic Ketoacidosis , Sepsis , Biomedical Research , Diabetes Mellitus , Diagnosis , Schools , MethodsABSTRACT
Diabetic ketoacidosis ( DKA ) is one of the common endocrine emergencies. With the development and applications of new drugs, the inducing causes of DKA become more and more complicated. We as clinicians should quickly and accurately evaluute the severity of DKA, and administrate reasonable rehydration and hypoglycemic treatment. What we should do better is searching the causes of DKA and help patients reasonably avoid its occurrence. In this article, two cases from clinical practice are analyzed.
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Objective To investigate the relationship between platelet-to-lymphocyte ratio(PLR) and the prognosis of diabetes ketoacidosis (DKA).Methods 120 patients with DKA were divided into two groups:the DKA survived group (n=86) and the DKA died group (n=34).80 patients with type 2 diabetes (T2DM)were also enrolled in our study as the control group.Their clinical and biochemical parameters were determined.PLR was calculated by blood routine examination.Results Patients in the DKA died group had higher PLR than patients in the DKA survived group and the control group.According to logistic regression analysis,age [OR=2.119(95％CI 1.506-3.994),P=0.032],infection [OR=2.047(95％ CI 1.421-3.885),P=0.021],Glasgow coma score [OR=0.523(95％ CI 0.394-0.693),P=O.O11],simultaneous other organ dysfunction [OR=3.642 (95％ CI 2.287-5.442),P=0.006],PLR[OR=3.073 (95％ CI 1.951-5.142),P＜0.001],mechanical ventilation [OR=3.846 (95％ CI 2.623-5.113),P＜0.001] and lactic acid [0R=2.854 (95％ CI 1.514-4.216,P=0.008] were all significantly correlated with the prognosis of DKA.The optimal cutoff value of PLR for predicting the prognosis of DKA was 192.26.Its sensitivity and specificity were 82.40％ and 67.60％,respectively.Conclusion PLR can be used as a sensitive indicator to predict the prognosis of DKA.
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Background: Diabetic ketoacidosis (DKA) is increasing in patients with type 2 diabetes in Asian countries. However, there is little information regarding the frequency and characteristics of DKA for Malaysian population. Objective: To identify the different clinical and biochemical features of DKA between adult patients with type 1 and type 2 diabetes. Methods: A cross-sectional, retrospective study was performed at University Malaya Medical Centre (UMMC) between January 2000 and December 2005. All patients (aged \>18 years) with type1 or type 2 diabetes were included in this study. Clinical and biochemical characteristics of DKA were studied. Precipitating factors for the development of DKA were also identified. Results: One hundred and twenty patients (61.9%) presented with DKA had type 2 diabetes. Both type 1 and type 2 patients had similar symptoms. Nausea (44.0%) and vomiting (66.4%) were most common symptoms of DKA. Infection (40.5%) was main precipitating factors of DKA. Blood pH level in previously-diagnosed type 1 diabetes patients was lower than that in previously-diagnosed type 2 diabetes (7.18±0.18 vs. 7.26±0.16, p \< 0.0001). Conclusion: A high proportion of DKA occurs in patients with type 2 diabetes. DKA developed severely in newly-diagnosed type 2 diabetes patients more than in previously-diagnosed type 2 diabetes patients.
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Los pacientes con Diabetes Mellitus tipo 1, (DM1), pueden presentar al inicio de su enfermedad una forma aguda, con cetoacidosis diabética (CAD), pero también pueden debutar en forma menos dramática, más tardía e insidiosa. Por esto, no siempre es fácil clasificar a un paciente diabético como tipo 1 o tipo 2. Sim embargo, el plan de Garantías en Salud (GES) exige una clasificación exacta para que los pacientes puedan optar a los diferentes beneficios que éste les brinda, ya que estos son distintos dependiento del tipo de diabetes. En los últimos 10 años se ha descrito una serie de cuadros clínicos que comparten tanto elementos clínicos como de laboratorio que pueden dificultar el diagnóstico diferencial. Entre ellos, se describe a la DM tipo 2 con propensión a la cetosis, más frecuente en población latina; los pacientes LADA (Late autoinmune diabetes onset) entidad de patogenia autoinmune al igual que la DM1 pero de comienzo más tardío y que carece de CAD; la Diabetes Mellitus Atípica (DMA), en pacientes jóvenes que debutan con CAD pero no requieren de insulina hasta años después del diagnóstico. Nuevas herramientas diagnósticas, entre ellas marcadores inmunológicos como los anticuerpos anti-islote y anti-GAD, y la determinación de péptido-C, se han mostrado útiles como elementos para diferenciar entre estos cuadros y evaluar la real necesidad de insulina exógena a permanencia.
Diabetes mellitus type (DM1) patients may present at the beginning of their illness an acute form with diabetic ketoacidosis (DAC), but may also debut in a less dramatic, insidious way. Therefore, it is not always easy to classify a patient as a diabetic type 1 or type 2. However, the GES (Explicit Health Guarantees) plan requires an accurate classification for the patients to be eligible for the various benefits it provides, because these are different depending on the type of diabetes. Over the last 10 years a range of clinical conditions have been described, sharing both clinical and laboratory elements which may hamper the differential diagnosis. Among them, Cetosis-prone type 2 diabetes, more common in latin population; LADA (Late autoimmune diabetes onset), an autoimmune desease, but unlike DM1, does not presen DAC; Atypical Diabetes Mellitus (ADM), in young patients with CAD debut but who do not require insulin until several years after diagnosis. New diagnostic tools, including immunoligical markers such as ICA and anti-GAD antibodies, and the determination of C-peptide, have been shown useful as exams to differentiate between these clinical pictures and assess the real need of exogenous insulin.
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Humans , Diabetes Mellitus, Type 1/diagnosis , Diagnosis, DifferentialABSTRACT
Objective To analyze the etiology of diabetes ketoacidosis(DKA) in children with type 1 diabetes.Methods Totally 850 person-time of type 1 diabetes children in recent 20 years in our hospital were selected as studied subjects. Two hundred and twenty-five person-time of them were hospitalized because of DKA.Fifty-six cases (131 person-time) were due to recurrent DKA.These patients were classified into 2 groups according to onset time: group 1(diagnosed from 1982 to 1991) and group 2(diagnosed from 1992 to 2001).Results The analysis of recurrent DKA suggested that 71.8 % of them was due to infection, 20.4 % of them did not obey diabetic diet and 9.2 % of them discontinued insulin injection. The etiology of DKA showed no difference in two groups. The number of recurrent DKA in two groups was significantly different (P