Initial management of diabetic ketoacidosis and prognosis according to diabetes type: a French multicentre observational retrospective study
Abstract Background Guidelines for the management of diabetic ketoacidosis (DKA) do not consider the type of underlying diabetes. We aimed to compare the occurrence of metabolic adverse events and the recovery time for DKA according to diabetes type. Methods Multicentre retrospective study conducted...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2019-08-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13613-019-0567-y |
| _version_ | 1819195671566090240 |
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| author | Adrien Balmier Fadia Dib Arnaud Serret-Larmande Etienne De Montmollin Victorine Pouyet Benjamin Sztrymf Bruno Megarbane Abirami Thiagarajah Didier Dreyfuss Jean-Damien Ricard Damien Roux |
| author_facet | Adrien Balmier Fadia Dib Arnaud Serret-Larmande Etienne De Montmollin Victorine Pouyet Benjamin Sztrymf Bruno Megarbane Abirami Thiagarajah Didier Dreyfuss Jean-Damien Ricard Damien Roux |
| author_sort | Adrien Balmier |
| collection | DOAJ |
| description | Abstract Background Guidelines for the management of diabetic ketoacidosis (DKA) do not consider the type of underlying diabetes. We aimed to compare the occurrence of metabolic adverse events and the recovery time for DKA according to diabetes type. Methods Multicentre retrospective study conducted at five adult intermediate and intensive care units in Paris and its suburbs, France. All patients admitted for DKA between 2013 and 2014 were included. Patients were grouped and compared according to the underlying type of diabetes into three groups: type 1 diabetes, type 2 or secondary diabetes, and DKA as the first presentation of diabetes. Outcomes of interest were the rate of metabolic complications (hypoglycaemia or hypokalaemia) and the recovery time. Results Of 122 patients, 60 (49.2%) had type 1 diabetes, 28 (22.9%) had type 2 or secondary diabetes and 34 (27.9%) presented with DKA as the first presentation of diabetes (newly diagnosed diabetes). Despite having received lower insulin doses, hypoglycaemia was more frequent in patients with type 1 diabetes (76.9%) than in patients with type 2 or secondary diabetes (50.0%) and in patients with newly diagnosed diabetes (54.6%) (p = 0.026). In contrast, hypokalaemia was more frequent in the latter group (82.4%) than in patients with type 1 diabetes (57.6%) and type 2 or secondary diabetes (51.9%) (p = 0.022). The median recovery times were not significantly different between groups. Conclusions Rates of metabolic complications associated with DKA treatment differ significantly according to underlying type of diabetes. Decreasing insulin dose may limit those complications. DKA treatment recommendations should take into account the type of diabetes. |
| first_indexed | 2024-12-23T02:16:28Z |
| format | Article |
| id | doaj.art-8345b3c23e3243be8f54c32f87e3e1db |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-23T02:16:28Z |
| publishDate | 2019-08-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-8345b3c23e3243be8f54c32f87e3e1db2022-12-21T18:03:39ZengSpringerOpenAnnals of Intensive Care2110-58202019-08-01911810.1186/s13613-019-0567-yInitial management of diabetic ketoacidosis and prognosis according to diabetes type: a French multicentre observational retrospective studyAdrien Balmier0Fadia Dib1Arnaud Serret-Larmande2Etienne De Montmollin3Victorine Pouyet4Benjamin Sztrymf5Bruno Megarbane6Abirami Thiagarajah7Didier Dreyfuss8Jean-Damien Ricard9Damien Roux10Intensive Care Unit, Louis Mourier Hospital, AP-HPINSERM, CIC 1417, F-CRIN, I-REIVACDepartment of Epidemiology, Biostatistics and Clinical Research, Bichat-Claude-Bernard Hospital, Université de Paris, AP-HPIntensive Care Unit, Centre Hospitalier de Saint-Denis, Hopital DelafontaineIntensive Care Unit, Hôpital René-DubosService de Réanimation polyvalente et surveillance continue, Université Paris Sud, Hôpital Antoine Béclère, AP-HPDepartment of Medical and Toxicological Critical Care, Lariboisière Hospital, AP-HP, Université de ParisIntensive Care Unit, Louis Mourier Hospital, AP-HPIntensive Care Unit, Louis Mourier Hospital, AP-HPIntensive Care Unit, Louis Mourier Hospital, AP-HPIntensive Care Unit, Louis Mourier Hospital, AP-HPAbstract Background Guidelines for the management of diabetic ketoacidosis (DKA) do not consider the type of underlying diabetes. We aimed to compare the occurrence of metabolic adverse events and the recovery time for DKA according to diabetes type. Methods Multicentre retrospective study conducted at five adult intermediate and intensive care units in Paris and its suburbs, France. All patients admitted for DKA between 2013 and 2014 were included. Patients were grouped and compared according to the underlying type of diabetes into three groups: type 1 diabetes, type 2 or secondary diabetes, and DKA as the first presentation of diabetes. Outcomes of interest were the rate of metabolic complications (hypoglycaemia or hypokalaemia) and the recovery time. Results Of 122 patients, 60 (49.2%) had type 1 diabetes, 28 (22.9%) had type 2 or secondary diabetes and 34 (27.9%) presented with DKA as the first presentation of diabetes (newly diagnosed diabetes). Despite having received lower insulin doses, hypoglycaemia was more frequent in patients with type 1 diabetes (76.9%) than in patients with type 2 or secondary diabetes (50.0%) and in patients with newly diagnosed diabetes (54.6%) (p = 0.026). In contrast, hypokalaemia was more frequent in the latter group (82.4%) than in patients with type 1 diabetes (57.6%) and type 2 or secondary diabetes (51.9%) (p = 0.022). The median recovery times were not significantly different between groups. Conclusions Rates of metabolic complications associated with DKA treatment differ significantly according to underlying type of diabetes. Decreasing insulin dose may limit those complications. DKA treatment recommendations should take into account the type of diabetes.http://link.springer.com/article/10.1186/s13613-019-0567-yDiabetic ketoacidosisHypoglycaemiaHypokalaemiaInsulinCritical careType 1 diabetes |
| spellingShingle | Adrien Balmier Fadia Dib Arnaud Serret-Larmande Etienne De Montmollin Victorine Pouyet Benjamin Sztrymf Bruno Megarbane Abirami Thiagarajah Didier Dreyfuss Jean-Damien Ricard Damien Roux Initial management of diabetic ketoacidosis and prognosis according to diabetes type: a French multicentre observational retrospective study Annals of Intensive Care Diabetic ketoacidosis Hypoglycaemia Hypokalaemia Insulin Critical care Type 1 diabetes |
| title | Initial management of diabetic ketoacidosis and prognosis according to diabetes type: a French multicentre observational retrospective study |
| title_full | Initial management of diabetic ketoacidosis and prognosis according to diabetes type: a French multicentre observational retrospective study |
| title_fullStr | Initial management of diabetic ketoacidosis and prognosis according to diabetes type: a French multicentre observational retrospective study |
| title_full_unstemmed | Initial management of diabetic ketoacidosis and prognosis according to diabetes type: a French multicentre observational retrospective study |
| title_short | Initial management of diabetic ketoacidosis and prognosis according to diabetes type: a French multicentre observational retrospective study |
| title_sort | initial management of diabetic ketoacidosis and prognosis according to diabetes type a french multicentre observational retrospective study |
| topic | Diabetic ketoacidosis Hypoglycaemia Hypokalaemia Insulin Critical care Type 1 diabetes |
| url | http://link.springer.com/article/10.1186/s13613-019-0567-y |
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