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Prognostic factors and all-cause mortality in patients with type 2 diabetes presenting with diabetic ketoacidosis: a population based, case- control study

Introduction: Little is known about diabetic ketoacidosis (DKA) in type 2 diabetes mellitus (T2DM). Moreover, the clinical impact of diabetic ketosis (DK) in T2DM is elusive. The aim of this study was to analyze characteristics and mortality of patients with DKA and DK and to identify possible prognostic factors. Methods: This was a population-based, cross- sectional study that included all patients with T2DM presenting to emergency department with DKA, over the 5-year period. We analyzed all first admissions of 137 patients with DKA and 137 age- and gender-matched patients with non- ketotic hyperglycemia (NKH) and DK. Results: During a median follow-up of 35.0 months, 55 (39.9%) patients in the NKH group, 32 (23.2%) patients in the DK group and 61 (44.2%) patients in the DKA group died. Patients with DKA had significantly higher mortality rates when compared with DK (HR 2.55, 95% CI 1.65–3.92, P<0.001) and NKH (HR 1.27, 95% CI 1.05–1.53, P=0.012). In patients with DKA, age, serum urea and sodium, the use of calcium channel antagonists, ASA and insulin therapy correlated positively with mortality, while weight loss and increased body temperature prior to the DKA episode, smoking and alcohol consumption were associated with decreased mortality. A nomogram derived from these variables predicted mortality with a sensitivity of 69.7%, specificity of 90.0% (AUC=0.866). Conclusion: DK and DKA represent two distinct subgroups of patients with T2DM. A nomogram derived from independent prognostic factors may have important clinical role in selecting high risk patients with DKA.

diabetic ketoacidosis, mortality, type 2 diabetes mellitus

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