engleski

Diabetic ketosis during hyperglycemic crisis is associated with decreased all-cause mortality in patients with type 2 diabetes mellitus

Purpose: Patients with type 2 diabetes mellitus (T2DM) have impaired ketogenesis due to high serum insulin and low growth hormone levels. Evidence exists that ketone bodies might improve kidney and cardiac function. In theory, improved ketogenesis in diabetics may have positive effects. We aimed to assess the impact of diabetic ketosis (DK) on all-cause mortality in patients with T2DM presenting with hyperglycemic crisis. Methods: We analyzed 486 patients with DK and 486 age- and sex-matched patients with nonketotic hyperglycemia (NKH) presenting to the emergency department. Cox proportional hazard models were used to analyze the link between patient characteristics and mortality. Results: During an observation time of 33.4 months, death of any cause occurred in 40.9% of the NKH group and 30.2% of the DK group (hazard ratio in the DK group, 0.63 ; 95% confidence interval 0.48 - 0.82 ; P = 0.0005). Patients with DK had a lower incidence of symptomatic heart failure and had improved renal function. They used less furosemide and antihypertensive drugs, more metformin and lower insulin doses, all of which was independently associated with decreased mortality. Plasma glucose and glycated hemoglobin levels were similar in both groups. Conclusions: Patients with hyperglycemic crisis and DK have decreased all-cause mortality when compared to those with NKH. DK might be a compensatory mechanism rather than a complication in patients with hyperglycemic crises, but further prospective studies are warranted.

type 2 diabetes mellitus ; ketosis ; ketogenesis ; mortality ; heart failure ; kidney disease

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