Mortality after discharge from hospital following an episode of diabetic ketoacidosis.

AIMS: The rate of inpatient mortality associated with diabetic ketoacidosis (DKA) has steadily decreased in recent decades. However, there remains a significantly increased outpatient death rate following an episode of survived DKA. We undertook this study to investigate the observed increase in mortality following an episode of DKA. METHODS: We completed a retrospective cohort study to investigate rates and causes of death in people admitted to our hospital with DKA between 2013 and 2018. DKA was confirmed by pre-defined biochemical parameters and cause of death data was extracted from multiple sources. Follow-up was for two years after discharge for all participants with one-year mortality being the main time point for analysis. RESULTS: We identified 818 admissions to hospital with DKA, affecting 284 people. Twenty people died as inpatients and a further 40 people died during the two-year follow-up. Of these 60 participants, cause of death was able to be determined for 41 (68%), with most deaths occurring due to infection or macrovascular disease. Risk factors for death within a year of hospital discharge included older age, vascular complications of diabetes, intellectual impairment and residential care living. Those who survived an episode of DKA had a one-year age-corrected mortality rate 13 times higher than the general population. This was more marked in the younger cohort with those aged 15-39 years being 49 times more likely to die in the year after surviving a DKA admission compared to their general population counterparts. CONCLUSION: An episode of diabetic ketoacidosis is associated with a significant outpatient mortality risk with most deaths due to infectious or macrovascular causes. This study should prompt investigation of predictive scoring tools to identify those at increased mortality risk after DKA and encourage the development of targeted interventions to reduce mortality.

Understanding the new HbA1c units for the diagnosis of Type 2 diabetes.

In New Zealand laboratories the measurement of glycated haemoglobin (HbA1c) for diagnosis of diabetes is now only reported in SI units of mmol/mol. HbA1c is now recommended as the preferred test to diagnose diabetes in most circumstances. The requirement for a second positive test in asymptomatic individuals is retained. An HbA1c greater than and equal to 50 mmol/mol (repeated on a second occasion in asymptomatic patients) is diagnostic of diabetes and a value less than and equal to 40 mmol/mol represents normal glucose tolerance. For patients with an initial HbA1c result of 41-49 mmol/mol, cardiovascular risk assessment and lifestyle interventions are recommended with repeat HbA1c screening in 6-12 months. For patients whose HbA1c is less than and equal to 40 mmol/mol, repeat screening (including for CVD risk) at intermittent intervals is recommended as per published guidelines.

Metabolic characteristics of patients with apparently normal fasting plasma glucose.

AIMS: To describe the prevalence of dysglycaemia in patients with fasting glucose <6.1 mmol/L. METHODS: Consecutive patients referred for OGTT between July 2002 and December 2003 to eight Diagnostic Medical Laboratory depots in the Auckland region of New Zealand were invited to participate. In addition to a standard OGTT, patients' BMI was calculated and HbA1c, fructosamine, lipids, and insulin concentrations were measured. Patients were grouped according to fasting glucose of <5.5 mmol/L=normal, 5.5-6.0 mmol/L="high fives", 6.1-6.9 mmol/L="old" impaired fasting glucose, and greater than and equal to 7 mmol//L=diabetes. RESULTS: 310 patients were studied. 111 patients had a fasting glucose of <5.5 mmol/L, and of these, 23 had IGT and 2 diabetes on OGTT; 85 patients had a fasting glucose 5.5-6.0 mmol/L, and 18 of these had IGT and 11 diabetes on OGTT; 75 patients had a fasting glucose of 6.1-6.9 mmol/L, and of these, 33 had IGT and 21 diabetes on OGTT; 39 patients had a fasting glucose greater than and equal to 7 mmol/L and 38 were confirmed diabetic on OGTT. CONCLUSION: This study suggests that the upper limit of normal fasting glucose be lowered to <5.5 mmol/L in line with Australian and American Diabetes Society guidelines.