Precipitating risk factors, clinical presentation, and outcome of diabetic ketoacidosis

Diabetic ketoacidosis (DKA) is a life-threatening but preventable complication of diabetes mellitus (DM) characterized by uncontrolled hyperglycemia (>13.9 mmol/L), ketosis and metabolic acidosis, which occurs due to a relative or complete lack of insulin. The aim of this study was to investigate the incidence and predisposing factors of DKA and its consequences. All DM patients, who had been hospitalized due to DKA in Riga East Clinical Hospital, Latvia during 2015 – 2019, were included in a retrospective study. Predisposing factors, clinical presentation, biochemical parameters and predictors of mortality were evaluated. Data were processed using IBM SPSS statistical analysis. 445 (mean age 51.7 ± 19.0; min 18, max 90 years) patients with DKA were included in the study. The rate of readmission was high as 7 patients were responsible for 24 admissions. The majority (47.9%) were type 2 DM patients. Median initial blood glucose was 24 mmol/L (IQR 18.2-31.4). Severe DKA was more frequent than moderate and mild forms (47.2%, versus 34.7% and 18.1%, respectively). The most common precipitating factors of DKA were newly diagnosed diabetes mellitus(n=166(38.2%)), delay of diabetes treatment intensification(n=97(22.4%)), discontinuation of or inadequate insulin injections(n= 51(11.8%)), alcohol abuse(n=50 (11.5%)), infection (n=37(8.5%)), and cerebrovascular accidents(n=33 (7.6%)). HbA1c levels were highest in new-onset type 1 diabetes group 12.3 ± 1.2% followed by insulin omission 11.1 ± 1.9 %, p=0.05. DKA hospitalization rate has declined from 2015 (n=108) to 2019 (n=61). Median length of hospital stay was 8 days (IQR 5-12). The most common complication was hypokalemia (34.7%). Newly diagnosed DM and insulin omission were the main factors associated with DKA. Although the continued decline in DKA admission rates is encouraging, rates have remained to be high and further work might help identify populations at risk.