medwireNews: Diabetic ketoacidosis (DKA) is three times more common with type 1 diabetes than with type 2 diabetes, but episode presentation and severity are similar between the two groups, show data presented at the virtual 57th EASD Annual Meeting.
This suggests “that the same protocol is equally effective in either type of diabetes,” Katrina Nash, from the University of Birmingham in the UK told delegates at the meeting.
Nash and team found that the majority (75.9%) of 768 consecutive diabetic ketoacidosis episodes treated at one UK tertiary care center between 2014 and 2020 occurred among people with type 1 diabetes. Just under a quarter (24.1%) of cases were in people with type 2 diabetes.
She reported that individuals with type 1 diabetes were significantly younger than those with type 2 diabetes (median 29.0 vs 61.5 years) and were significantly less likely to be of non-White ethnicity (19.7 vs 26.5%). Overall, 49.1% of cases were among men and 50.9% among women.
The most common precipitating causes of DKA in the full cohort were intercurrent illness (39.7%) followed by suboptimal treatment compliance (26.7%), but Nash noted that intercurrent illness was a less common cause in type 1 than type 2 diabetes (37.2 vs 48.1%) whereas suboptimal compliance was more common (30.2 vs 16.2%). In both groups, approximately 16% of DKA episodes had an unknown precipitating etiology.
Severity of diabetic ketoacidosis at presentation was similar in both type 1 and type 2 diabetes when assessed by median pH (7.22 vs 7.24) and glucose level (approximately 28.0 vs 27.0 mmol/L), but urea levels were significantly lower in people with type 1 versus type 2 diabetes (7.1 vs 8.9 mmol/L).
In terms of management, there were no significant differences between the two groups in insulin or fluid requirements, nor in the total duration of DKA, at 13.9 hours in both groups.
However, people with type 1 diabetes had significantly shorter hospital stays than those with type 2 diabetes, at medians of 3.0 and 11.0 days, respectively.
Nash said that this difference “was maintained after controlling for age, sex, and ethnicity” and may reflect “a more complex need of care” among the people with type 2 diabetes.
She also presented data according to serum osmolality, showing that, overall, individuals with high serum osmolality (>320 mmol/L) had higher glucose, lactate, and urea levels at presentation, more hyperkalemic and fewer hypokalemic episodes, and longer hospital stays than those with low osmolality.
Of note, these differences did not impact DKA duration overall, but people with type 1 diabetes and high serum osmolality had longer DKA durations than those with low osmolality.
Nash commented: “As our results indicate that patients with higher serum osmolality may be sicker, this may inform medical practice to alert front-line workers.”
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