ISSN 1849-9031 (Online)

ISSN 1849-8922    (Print)

Incidence of diabetic ketosis and ketoacidosis in Caucasian adults with type 2 diabetes mellitus: a population-based study.
Ivan Kruljac, Miroslav Ćaćić, Petra Ćaćić, Lora Stanka Kirigin, Vedran Ostojić, Mario Štefanović, Milan Vrkljan.



Aims: We aimed to analyze incidence and characteristics of patients with diabetic ketosis (DK) and diabetic ketoacidosis (DKA) in Caucasian adults with type 2 diabetes mellitus (T2DM).

Methods: Studied population included 261,749 adults. DK criteria included plasma glucose >13.9 mmol/L and ketonuria >2, while in DKA bicarbonate <18 mEq/L or pH<7.30 was also required. Hyperglycemic crises without these criteria were defined as non-ketotic hyperglycemia (NKH).

Results: During a 5-year period, we observed 630 episodes of DK and 215 episodes of DKA. Only 8.6% of DK episodes and 34.4% of DKA were attributed to type 1 diabetes mellitus (T1DM). Patients with T1DM were younger, leaner, majority had newly diagnosed disease, and hyperglycemia was the main cause of admission. Standardized incidence ratio for DK was 48.1 (95% confidence interval [CI] 44.5-52.1) and 17.0 (95% CI 14.9-19.4) for DKA. Incidence for both DK and DKA was increasing with age. In patients younger than 50, the incidence of DK and DKA was similar. However, dramatic rise in the incidence of DK was observed in both sexes after the age of 50. When compared with patients with NKH, the patients with DK had higher serum pH and bicarbonates. Patients with T2DM had a risk of 0.8% for developing DKA and 2.9% for DK over 5-year period.

Conclusions: Our study showed that DK and DKA are not uncommon in Caucasian adults and the majority of episodes were contributed to T2DM. Incidence of DK is far more higher than the incidence of DKA in patients older than 50, who predominantly have T2DM. Moreover, patients with DK have higher serum pH and bicarbonates, both of which imply that DK and DKA are distinct clinical entities in patients with T2DM. Further studies are needed to assess the impact of these clinical entities.