Original Article-Triggers in Diabetic Ketoacidosis and Predictors of Adverse Outcome

Abstract

Diabetic ketoacidosis (DKA) though much more common in type 1 diabetes, patients with type 2 diabetes mellitus are also susceptible to DKA. An analysis and overview of the different clinical characteristics of diabetic ketoacidosis in patients with type 1 and type 2 diabetes is needed. Aims- To study the precipitating factors triggering diabetic ketoacidosis.2. To compare the clinical and biochemical characteristics of type 1 versus type 2 diabetes mellitus (DM) and to assess the outcome in patients with DKA. Materials and Methods- This prospective study was conducted in 50 hospitalized patients with diabetic ketoacidosis. Patients were classified as having type 1 or type 2 on the basis of age and treatment history. Groups were compared for differences in clinical presentation, precipitating factors and biochemical profiles at the time of admission. Statistical analysis used: Statistical Package for the Social Sciences (SPSS) software (t- test) Results: 50 cases of diabetic ketoacidosis admitted in emergency were selected for study. Male: Female ratio was 1:1. 27 (54%) were type 1 diabetes mellitus(DM) and 23(46%) type 2 DM on the basis of age and treatment history. 19(28%) were on insulin alone and 13(26%) cases were new patients presenting with DKA. In type 1 DM, the mean age was 23.5 years whereas it was 49.6 years for type 2 DM. 24(48%) episodes of DKA occurred in patients less than 30 and 8(16%) episodes were observed in those between 51- 70 years of age. Vomiting, pain abdomen, altered sensorium were common symptoms observed on presentation in addition to symptoms of precipitating factors like cough, burning micturition, fever etc. The trigger for the development of DKA was identified in44 (88%) patients. Commonest precipitating factor for DKA in Type 1 DM cases was noncompliance with insulin seen in 14(51.9%) followed by infections in 12(44.4%). In Type 2 DM cases most common precipitating factor was infection in 16 (69.8%). Mortality was 3(6%). They had associated comorbidities. The mean bicarbonate was 5.4 mEq/ L for the expired group and 14.5 mEq/L for the survived group (P value 0.02). Conclusions: - A significant proportion of DKA occurs in patients with type 2 diabetes. DKA may be the first presentation of diabetes. A precipitating factor for the development of DKA should be searched for during initial evaluation for optimal management and favorable outcome. Overall infections account for majority of DKA in type 2 and omission of insulin in type 1DM. Very low bicarbonate levels at admission may predict mortality.