Increased risk of death following recurrent ketoacidosis admissions: a Brazilian cohort study of young adults with type 1 diabetes
Abstract Background Recurrent DKA (rDKA) remains an acute type 1 diabetes complication even in post-insulin era. This study aimed to analyze the predictors and effects of rDKA on the mortality of patients with type 1 diabetes. Methods Patients hospitalized (n = 231) wih diabetic ketoacidosis (betwee...
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | Diabetology & Metabolic Syndrome |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13098-023-01054-5 |
| _version_ | 1797836343254974464 |
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| author | Sarah S. Santos Luana A. L. Ramaldes Patricia M. Dualib Monica A. L. Gabbay João R. Sá Sergio A. Dib |
| author_facet | Sarah S. Santos Luana A. L. Ramaldes Patricia M. Dualib Monica A. L. Gabbay João R. Sá Sergio A. Dib |
| author_sort | Sarah S. Santos |
| collection | DOAJ |
| description | Abstract Background Recurrent DKA (rDKA) remains an acute type 1 diabetes complication even in post-insulin era. This study aimed to analyze the predictors and effects of rDKA on the mortality of patients with type 1 diabetes. Methods Patients hospitalized (n = 231) wih diabetic ketoacidosis (between 2007 and 2018) were included. Laboratorial and clinical variables were collected. Mortality curves were compared in four groups: diabetic ketoacidosis as a new-onset type 1 diabetes (group A), single diabetic ketoacidosis episode after diagnosis of type 1 diabetes (group B), 2–5 diabetic ketoacidosis events (group C), and > 5 diabetic ketoacidosis events during follow-up period (group D). Results During the follow-up period (approximately 1823 days), the mortality rate was 16.02% (37/231). The median age at death was 38.7 years. In the survival curve analysis, at 1926 days (5 years), the probabilities of death were indicated by ratios of 7.78%, 4.58%, 24.40%, and 26.63% in groups A, B, C, and D, respectively. One diabetic ketoacidosis episode compared with ≥ 2 events had a relative risk of 4.49 (p = 0.004) of death and > 5 events had 5.81 (p = 0.04). Neuropathy (RR 10.04; p < 0.001), retinopathy (relative risk 7.94; p < 0.01), nephropathy (RR 7.10; p < 0.001), mood disorders (RR 3.57; p = 0.002), antidepressant use (RR 3.09; p = 0.004), and statin use (RR 2.81; p = 0.0024) increased the risk of death. Conclusions Patients with type 1 diabetes with > 2 diabetic ketoacidosis episodes have four times greater risk of death in 5 years. Microangiopathies, mood disorders, and use of antidepressants and statins were important risk factors for short-term mortality. |
| first_indexed | 2024-04-09T15:07:16Z |
| format | Article |
| id | doaj.art-46f5a10e27a44f3c91236d2337c1c2f0 |
| institution | Directory Open Access Journal |
| issn | 1758-5996 |
| language | English |
| last_indexed | 2024-04-09T15:07:16Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Diabetology & Metabolic Syndrome |
| spelling | doaj.art-46f5a10e27a44f3c91236d2337c1c2f02023-04-30T11:22:52ZengBMCDiabetology & Metabolic Syndrome1758-59962023-04-011511710.1186/s13098-023-01054-5Increased risk of death following recurrent ketoacidosis admissions: a Brazilian cohort study of young adults with type 1 diabetesSarah S. Santos0Luana A. L. Ramaldes1Patricia M. Dualib2Monica A. L. Gabbay3João R. Sá4Sergio A. Dib5Department of Medicine, Endocrinology Division, Diabetes & Endocrinology Center, Escola Paulista de Medicina, Universidade Federal de Sao PauloDepartment of Medicine, Endocrinology Division, Diabetes & Endocrinology Center, Escola Paulista de Medicina, Universidade Federal de Sao PauloDepartment of Medicine, Endocrinology Division, Diabetes & Endocrinology Center, Escola Paulista de Medicina, Universidade Federal de Sao PauloDepartment of Medicine, Endocrinology Division, Diabetes & Endocrinology Center, Escola Paulista de Medicina, Universidade Federal de Sao PauloDepartment of Medicine, Endocrinology Division, Diabetes & Endocrinology Center, Escola Paulista de Medicina, Universidade Federal de Sao PauloDepartment of Medicine, Endocrinology Division, Diabetes & Endocrinology Center, Escola Paulista de Medicina, Universidade Federal de Sao PauloAbstract Background Recurrent DKA (rDKA) remains an acute type 1 diabetes complication even in post-insulin era. This study aimed to analyze the predictors and effects of rDKA on the mortality of patients with type 1 diabetes. Methods Patients hospitalized (n = 231) wih diabetic ketoacidosis (between 2007 and 2018) were included. Laboratorial and clinical variables were collected. Mortality curves were compared in four groups: diabetic ketoacidosis as a new-onset type 1 diabetes (group A), single diabetic ketoacidosis episode after diagnosis of type 1 diabetes (group B), 2–5 diabetic ketoacidosis events (group C), and > 5 diabetic ketoacidosis events during follow-up period (group D). Results During the follow-up period (approximately 1823 days), the mortality rate was 16.02% (37/231). The median age at death was 38.7 years. In the survival curve analysis, at 1926 days (5 years), the probabilities of death were indicated by ratios of 7.78%, 4.58%, 24.40%, and 26.63% in groups A, B, C, and D, respectively. One diabetic ketoacidosis episode compared with ≥ 2 events had a relative risk of 4.49 (p = 0.004) of death and > 5 events had 5.81 (p = 0.04). Neuropathy (RR 10.04; p < 0.001), retinopathy (relative risk 7.94; p < 0.01), nephropathy (RR 7.10; p < 0.001), mood disorders (RR 3.57; p = 0.002), antidepressant use (RR 3.09; p = 0.004), and statin use (RR 2.81; p = 0.0024) increased the risk of death. Conclusions Patients with type 1 diabetes with > 2 diabetic ketoacidosis episodes have four times greater risk of death in 5 years. Microangiopathies, mood disorders, and use of antidepressants and statins were important risk factors for short-term mortality.https://doi.org/10.1186/s13098-023-01054-5Diabetic ketoacidosisType 1 diabetes mellitusRecurrent diabetic ketoacidosisMortality |
| spellingShingle | Sarah S. Santos Luana A. L. Ramaldes Patricia M. Dualib Monica A. L. Gabbay João R. Sá Sergio A. Dib Increased risk of death following recurrent ketoacidosis admissions: a Brazilian cohort study of young adults with type 1 diabetes Diabetology & Metabolic Syndrome Diabetic ketoacidosis Type 1 diabetes mellitus Recurrent diabetic ketoacidosis Mortality |
| title | Increased risk of death following recurrent ketoacidosis admissions: a Brazilian cohort study of young adults with type 1 diabetes |
| title_full | Increased risk of death following recurrent ketoacidosis admissions: a Brazilian cohort study of young adults with type 1 diabetes |
| title_fullStr | Increased risk of death following recurrent ketoacidosis admissions: a Brazilian cohort study of young adults with type 1 diabetes |
| title_full_unstemmed | Increased risk of death following recurrent ketoacidosis admissions: a Brazilian cohort study of young adults with type 1 diabetes |
| title_short | Increased risk of death following recurrent ketoacidosis admissions: a Brazilian cohort study of young adults with type 1 diabetes |
| title_sort | increased risk of death following recurrent ketoacidosis admissions a brazilian cohort study of young adults with type 1 diabetes |
| topic | Diabetic ketoacidosis Type 1 diabetes mellitus Recurrent diabetic ketoacidosis Mortality |
| url | https://doi.org/10.1186/s13098-023-01054-5 |
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