Practice Update: DIABETES

AACE 2017 9

Three prognostic factors of mortality identified in patients with diabetic ketoacidosis Advanced age, admission to the intensive care unit, and deteriorating kidney function signify a poorer prognosis among type 2 diabetic patients with diabetic ketoacidosis, reports a retrospective, single-center review. Z areen Kiran, MBBS, of Aga Khan University Hospital, Karachi, Pakistan, and colleagues set out to determine prognostic factors associated with increased mortality in patients with type 2 diabetes admitted with diabetic ketoacidosis). They compared mortality of these patients for the period from 2010 to 2016 (n = 279) vs that observed from 1991–1996. Medical records of 279 such patients from 2010 to 2016 were reviewed. A total of 128 patients fulfilled criteria and were included. One-hundred and eighteen patients had a history of type 2 dia- betes mellitus whereas 10 patients had no history of diabetes or diabetic ketoacidosis. Mean patient age was 56.9 ± 12.4 years, 53.1% (n = 68) were males, and 46.9% (n = 60) were females. Ten (7.8%) patients suffered from severe; 68 (53.12%) patients, mod- erate; and 50 (39.1%), mild diabetic ketoacidosis. Mean age, duration of diabetes, hemoglobin, hemoglobin A1c, random blood sugar, and body mass index did not differ statis- tically significantly between the two groups. Two patients with severe, 8 patients with moderate, and six with mild diabetic ketoacidosis died. Age and creatinine level contributed significantly to risk of mortal- ity in univariate analysis (hazard ratio 1.05 and 1.23, respectively, P < 0.05). All variables used in univariate analysis were analyzed further for an adjusted model. Advanced age and admission to the intensive care unit were independent predictors of death (hazard ratio 1.06 and 5.85, respectively, P < 0.05). More patients with type 2 diabetes (n = 128) presented with diabetic ketoacidosis during 2010 to 2016 than from 1991 to 1996 (n = 57). Markedly less mortality (12.5%) of patients with type 2 diabetes admitted with diabetic ketoacidosis was observed during 2010 to 2016 than from 1991 to 1996 (21%). Factors related to this improvement included an inpatient endo- crine consultation service composed of an endocrine consultant; endocrine fellow; diabetes nurse; training of nurses staff, interns, and residents by endocrine faculty in managing diabetic ketoac- idosis; timely institution of insulin infusion protocols designed for managing diabetic ketoacidosis; and a greater number of more patients receiving expert care. Dr Kiran concluded that advanced age, admission to the intensive care unit, and deteriorating kidney function signify a poorer prog- nosis among type 2 diabetic patients with diabetic ketoacidosis. Though the number of patients with type 2 diabetes admitted with diabetic ketoacidosis increased a considerable decrease in mortality is attributed to a number of improvements in manag- ing diabetic ketoacidosis and the development of standardized protocols.

Results of this study revealed that the majority of women with gestational diabetes were not screened postpartum, as recom- mended. The observed lack of postpartum screening is similar to results of other studies, which found that most women with ges- tational diabetes are not retested at the end of the postpartum period. The majority of subjects with postpartum diabetes mellitus had received insulin therapy. Lack of communication after patient dis- charge may have explained the lack of follow-up. Text messages and telephone calls may improve follow-up in this population. Dr Igwe concluded that women with gestational diabetes who require insulin during pregnancy are at higher risk of postpartum diabetes mellitus than those who do not require insulin. Women with gestational diabetes should follow a long-term man- agement plan from pregnancy going forward to prevent being lost during follow-up.

PracticeUpdate Editorial Team

PracticeUpdate Editorial Team

VOL. 1 • NO. 1 • 2017