Materiały źródłowe

• #1 Adult Diabetic Ketoacidosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560723/

  Diabetic ketoacidosis incidence ranges from 0 to 56 per 1000 person-years, shown in different studies from different geographic areas. DKA has a higher prevalence rate among women and non-Whites. Incidence is higher among patients using injectable insulin compared to the subcutaneous insulin infusion pumps. […] Rates of DKA among children varies widely from country to country. The lowest incidence was found in Nigeria (2.9 cases per 100,000). The highest incidence rate was found in Sweden and Finland, with 41.0 and 37.4 per 100,000. […] In the United States, one study reported nursing home residents accounted for 0.7% of DKA. Increased mortality was associated with nursing home residence among patients with DKA. […] Diabetic ketoacidosis (DKA) is one of the life-threatening but preventable complications of diabetes. CDC’s United States Diabetes Surveillance System (USDSS) indicated an increase in hospitalization rates for DKA from 2009 to 2014, most notably in persons aged less than 45 years.

• #1 Diabetic ketoacidosis epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Diabetic_ketoacidosis_epidemiology_and_demographics

  In 2007, the incidence of diabetic ketoacidosis (DKA) was estimated to be 13 to 26 cases per 100,000 individuals worldwide. […] In the United States, the overall prevalence of diabetic ketoacidosis (DKA) among patients with type 1 diabetes mellitus during 2013-2014 was 3000 individuals per 100,000 patients. […] The annual incidence of diabetic ketoacidosis varies in different reports and is related to the geographic location. […] Worldwide, the annual incidence of diabetic ketoacidosis varies from a low of 13 persons per 100,000 persons (Denmark) to a high of 26 per 100,000 persons (Malaysia). […] Case-fatality rate of DKA varies from a low of less than 1000 per 100,000 individuals (USA and Scotland) to a high of 30,000 per 100,000 individuals (India). […] DKA is the most common cause of death in children and adolescents with type 1 diabetes and accounts for half of all deaths in diabetic patients younger than 24 years of age.

• #1 Trends in Diabetic Ketoacidosis Hospitalizations and In-Hospital Mortality — United States, 2000–2014 | MMWR

  https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a3.htm

  Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes, a disease that affects approximately 30 million persons in the United States. DKA is more common among persons with type 1 diabetes. […] After a slight decline during 2000-2009, hospitalizations for DKA increased in the United States during 2009-2014 among all age groups and were highest among persons aged 45 years. Concurrently, in-hospital case-fatality rates among persons with DKA consistently decreased from 2000 to 2014. […] DKA rates were age-adjusted using four age groups (45, 45-64, 65-74, and 75 years) from the 2000 U.S. Census. […] From 2000 to 2009, the age-adjusted rate of DKA hospitalizations among persons with diabetes fluctuated but declined at an average annual rate of 1.1%. During 2009-2014, however, the rate increased 54.9%, from 19.5 to 30.2 per 1,000 persons, at an average annual rate of 6.3%. The reversal in trend was apparent across all age groups and both sexes. Rates were highest in persons aged 45 years (44.3 per 1,000 in 2014) and lowest in persons aged 65 years (2.0 per 1,000).

• #1 Diabetic Ketoacidosis (DKA): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/118361-overview

  The incidence of diabetic ketoacidosis in developing countries is not known, but it may be higher than in industrialized nations. […] The incidence of DKA is higher in whites because of the higher incidence of type 1 diabetes in this racial group. The incidence of DKA is slightly greater in females than in males for reasons that are unclear. Recurrent DKA frequently is seen in young women with type 1 diabetes and is caused mostly by the omission of insulin treatment. […] Among persons with type 1 diabetes, DKA is much more common in young children and adolescents than it is in adults. DKA tends to occur in individuals younger than 19 years, but it may occur in patients with diabetes at any age. […] Although multiple factors (eg, ethnic minority, lack of health insurance, lower body mass index, preceding infection, delayed treatment) affect the risk of developing DKA among children and young adults, intervention is possible between symptom onset and development of DKA.

• #1 Lifetime risk and health-care burden of diabetic ketoacidosis: A population-based study

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9449722/

  Diabetic ketoacidosis (DKA) is a life-threatening complication of both type 1 and type 2 diabetes. We aimed to assess population-based rates, trends and outcomes of patients with DKA. […] In total, 5,544 hospitalizations with DKA were identified, of whom 3,847 were seen in patients with type 1 diabetes and 1,697 in type 2 diabetes. Incidence rates of DKA among patients with type 1 diabetes were highest during adolescence with 17.67 (girls) and 13.87 (boys) events per 100,000 person-years and decreased with age in both sexes thereafter. […] The population-based incidence rate of DKA increased over time from 7.22 per 100,000 person-years in 2010 to 9.49 per 100,000 person-years in 2018. […] In type 1 diabetes highest incidence rates of DKA hospitalizations were observed among adolescent females. In comparison, in patients with type 2 diabetes the risk for DKA steadily increased with age with higher rates in adult males.

• #1 Diabetic ketoacidosis – Epidemiology | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/162/epidemiology

  In the US from 2000-2009, the rate of hospitalizations for DKA decreased overall, from 21.9 to 19.5 in 1000 persons with diabetes, but then increased from 2009-2014 to 30.2 in 1000 persons with diabetes. […] In 2014, rates of hospitalization for DKA were highest among people aged 45 years (44.3 in 1000 persons with diabetes) and decreased with age (5.2 in 1000 persons with diabetes aged 45-64 years; 1.6 in 1000 65-74 years; and 1.4 in 1000 75 years). […] From 2000-2014, in-hospital mortality rates among people with DKA consistently decreased, from 1.1% to 0.4%. […] In 2014 in the US, about 207,000 emergency department visits for people aged 18 years were for hyperglycemic crises (e.g., DKA, hyperglycemic hyperosmolar state).

• #1 Diabetic ketoacidosis in children: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/diabetic-ketoacidosis-in-children-clinical-features-and-diagnosis

  Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus. It occurs at the time of diagnosis of type 1 diabetes in approximately 30 to 40 percent of children in the United States. […] In children with established diabetes, DKA occurs at rates of 6 to 8 percent per year. […] DKA can also occur in children with type 2 diabetes (and particularly in African American adolescents with obesity), although at lower rates than those observed in type 1 diabetes.

• #1 Diabetic Ketoacidosis (DKA): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/118361-overview

  Despite advancements in self-care of patients with diabetes, DKA accounts for 14% of all hospital admissions of patients with diabetes and 16% of all diabetes-related fatalities. Almost 50% of diabetes-related admissions in young persons are related to DKA. DKA frequently is observed during the diagnosis of type 1 diabetes and often indicates this diagnosis. While the exact incidence is not known, it is estimated to be 1 out of 2000. […] DKA occurs primarily in patients with type 1 diabetes. The incidence is roughly 2 episodes per 100 patient years of diabetes, with about 3% of patients with type 1 diabetes initially presenting with DKA. It can occur in patients with type 2 diabetes as well; this is less common, however. […] A study by Zhong et al found that in England, for adults with type 1 or type 2 diabetes, there was a growing incidence of hospitalization for DKA between 1998 and 2013. More specifically, the investigators reported that the incidence for patients with type 1 diabetes rose between 1998 and 2007 and then remained at the same level until 2013, while the incidence associated with type 2 diabetes expanded annually by 4.24% between 1998 and 2013.

• #1 Diabetic Ketoacidosis: Symptoms and Treatment | Doctor

  https://patient.info/doctor/diabetic-ketoacidosis

  DKA is normally seen in people with type 1 diabetes. Data from the UK National Diabetes Audit show a crude one-year incidence of 3.6% among people with type 1 diabetes. In the UK nearly 4% of people with type 1 diabetes experience DKA each year. About 6% of cases of DKA occur in adults newly presenting with type 1 diabetes. About 8% of episodes occur in hospital patients who did not primarily present with DKA. […] However, DKA may also occur in people with type 2 diabetes, although people with type 2 diabetes are much more likely to have a hyperosmolar hyperglycaemic state. Ketosis-prone type 2 diabetes tends to be more common in older, overweight, non-white people with type 2 diabetes, and DKA may be their first presentation of diabetes. […] Mortality rates have fallen significantly in a period of 20 years – from 7.96% to 0.67%. The mortality rate is still high in developing countries and among non-hospitalised patients. The main causes of mortality in the adult population include severe hypokalaemia, adult respiratory distress syndrome and comorbid states such as pneumonia, acute myocardial infarction and sepsis.

• #1 Pediatric Diabetic Ketoacidosis (DKA): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/907111-overview

  Diabetic ketoacidosis rates in children with established diabetes widely vary; in a United Kingdom national prospective study, 60% of all cases occurred in patients with known diabetes. […] A 2011 study analyzing 46 published reports reinforced the above statements. […] A multicenter study from Germany and Austria, using a database containing information on 28,770 children aged 19 years or younger, reported that the greatest risk of diabetic ketoacidosis in established cases of type 1 diabetes was in the early teenage years. […] Although no difference in diabetic ketoacidosis rates between the sexes is observed at diagnosis and during early childhood, adolescent girls with diabetes are more likely to develop diabetic ketoacidosis than adolescent boys. […] Infants and children younger than 5 years are at the greatest risk of presenting with diabetic ketoacidosis, because the diagnosis of diabetes in younger children is more difficult and is more likely to be delayed.

• #1 Lifetime risk and health-care burden of diabetic ketoacidosis: A population-based study

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9449722/

  DKA was associated with a high burden of disease reflected by high rates of intensive care unit admission, prolonged hospital stay and high mortality rates, especially in elderly. […] This population-based cohort study has three key findings: First, while among patients with type 1 diabetes the risk for DKA was highest among adolescents at around 15 years of age, in patients with type 2 diabetes the lifetime risk for DKA steadily increased with age. Second, in adolescence, females were predominantly prone to develop DKA, however in adults there was a switch towards higher rates in males. Third, incidence rates for DKA were increasing over time, especially among the elderly with relevant health-care burden.

• #1 Epidemiology of Diabetic Ketoacidosis in National Institute of Diabetes and Endocrinology (NIDE) by:Bassyouni, A.; El Ebrashy, I.; El Hefnawy, H | ICEECE2012 | 15th International & 14th European Congress of Endocrinology | Endocrine Abstracts

  https://www.endocrine-abstracts.org/ea/0029/ea0029p659

  Epidemiology of Diabetic Ketoacidosis in National Institute of Diabetes and Endocrinology (NIDE) by:Bassyouni, A.; El Ebrashy, I.; El Hefnawy, H […] Diabetic ketoacidosis (DKA) is the most serious acute metabolic complications of diabetes. […] The aim of our work was to determine the clinical characteristics, precipitating causes and mortality rate of patients with diabetic ketoacidosis in National Institute of Diabetes and Endocrinology. […] Our work is a retrospective study in which we reviewed and analyzed the data of all patients (1297 diabetics: 85.8% type1 and 14.2% type2 diabetics, 59.6% females and 40.4% males) who admitted to NIDE in Cairo, Egypt with diagnosis of DKA over the last three years. […] DKA among our study diabetics was attributed to non-compliance (45.5%), infection (27.2%), myocardial infraction (6.4%), and new-onset type 1 diabetes (20.9%).

• #1 Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Epidemiology and pathogenesis – UpToDate

  https://www.uptodate.com/contents/diabetic-ketoacidosis-and-hyperosmolar-hyperglycemic-state-in-adults-epidemiology-and-pathogenesis

  Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS, also called hyperosmotic hyperglycemic nonketotic state [HHNK]) are two of the most serious acute complications of diabetes. […] The epidemiology and the factors responsible for the metabolic abnormalities of DKA and HHS in adults will be discussed here. […] Diabetic ketoacidosis (DKA) is characteristically associated with type 1 diabetes. It also occurs in type 2 diabetes under conditions of extreme stress such as serious infection, trauma, cardiovascular or other emergencies, in association with sodium-glucose cotransporter 2 (SGLT2) inhibitor use, or as a presenting manifestation of type 2 diabetes in some populations, a disorder called ketosis-prone diabetes mellitus. […] DKA is more common in younger adults (aged 18 to 44 years). Coronavirus disease 2019 (COVID-19) infection has also been associated with greater risk of DKA in both type 1 and type 2 diabetes.

• #1 Incidence and determinants of diabetic ketoacidosis among people with diabetes in Woldiya comprehensive specialized hospital, Ethiopia: a retrospective cohort study | BMC Endocrine Disorders | Full Text

  https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-024-01552-1

  Diabetic ketoacidosis is an acute complication of diabetes mellitus that is characterised by hyperglycemia, acidosis, and ketonuria. […] To assess the incidence of Diabetic ketoacidosis and its determinants among adult people with diabetes at an Ethiopian Hospital. […] A total of 121 DKA occurred from 5471 person-months of observation. The overall incidence rate of diabetic ketoacidosis was found to be 2.2 per 100 person-months (95% CI: 1.8- 2.6). […] The overall incidence of diabetic ketoacidosis in study area was relatively high. Poor glycemic control, the presence of infection, and comorbidity were determinants of diabetic ketoacidosis. […] In Ethiopia, incidence of DKA in adult DM patients is unknown, but a study in Hawassa revealed that the prevalence of DKA was about 40%. […] The mortality rate varies from 2 to 5 percent and from 6 to 24 percent for developed and developing countries, respectively.

• #1 Diabetic ketoacidosis – Wikipedia

  https://en.wikipedia.org/wiki/Diabetic_ketoacidosis

  Diabetic ketoacidosis occurs in 4.6-8.0 per 1000 people with diabetes annually. […] Rates among those with type 1 diabetes are higher with about 4% in the United Kingdom developing DKA a year while in Malaysia the condition affects about 25% a year. […] In the United States, 135,000 hospital admissions occur annually as a result of DKA, at an estimated cost of $2.4 billion or a quarter to half the total cost of caring for people with type 1 diabetes. […] There has been a documented increasing trend in hospital admissions. […] The risk is increased in those with an ongoing risk factor, such as an eating disorder, and those who cannot afford insulin. […] About 30% of children with type 1 diabetes receive their diagnosis after an episode of DKA. […] Lower socioeconomic status and higher area-level deprivation are associated with an increased risk of diabetic ketoacidosis in people with diabetes mellitus type 1.

• #1

  https://journals.lww.com/tamj/fulltext/2017/45020/epidemiology_of_infection_as_a_precipitating.3.aspx

  Many cases of DKA are triggered by insulin cessation due to social, psychological, and economic reasons especially in developing countries. Infection, new onset of diabetes, and other comorbid states such as stroke, acute pancreatitis, and chronic renal failure are implicated in the development of DKA. […] The present study suggests infection as a principal precipitating factor for DKA in 93 (46.5%) patients. The most common source of infections was urinary tract infections (31.2%) and respiratory tract infections (26.8%). […] Infections were the precipitating factor in 60.3% of whom on premixed insulin, 55.5% of whom on oral treatment, 32.4% of whom on basal bolus with P value less than 0.001. This result supports the role of basal bolus insulin to be the best regimen of insulin in the control of blood glucose during periods of stress and illness.

• #1 Pediatric Diabetic Ketoacidosis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26827

  DKA is frequently present at diagnosis of type 1 diabetes (in approximately 3% percent of children in the United States and Canada) and, along with its complications, is the most common cause of hospitalization, mortality, and morbidity in children with type 1 diabetes mellitus. The fatality rate is approximately 0.15-0.31% of cases. DKA in children with type 2 diabetes is also observed but at lower rates. […] DKA occurs at the time of diagnosis of type 1 diabetes in approximately 30 percent of children in the United States and Canada. Factors that increase the likelihood of DKA at the initial presentation of type 1 diabetes in children are as follows: Young age (5 years of age and especially 2 years), Ethnic minority, Low socioeconomic status, Children living in countries with a low prevalence of type 1 diabetes, Delayed diagnosis of diabetes.

• #1 Treatment outcomes of diabetic ketoacidosis among diabetes patients in Ethiopia. Hospital-based study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0264626

  There was limited data on treatment outcomes among patients with diabetic ketoacidosis (DKA) in Ethiopia. […] The aim of the study was to determine the treatment outcomes of DKA patients attending Debre Tabor General Hospital. […] The primary outcomes were the treatment outcomes of DKA including (in-hospital glycemic control, the length of hospital stay and in-hospital mortality). […] The mean length of hospital stay was 4.64(2.802) days. […] The majority 370 (95.60%) of patients improved and discharged whereas 17 (4.40%) patients died in the hospital. […] New onset type 1 diabetes was the major precipitating factor for DKA. […] Admitted DKA patients remained in hospital for a duration of approximately five days. […] About five out of hundred DKA patients ended up with death in the hospital.

• #1 Diabetic ketoacidosis – Wikipedia

  https://en.wikipedia.org/wiki/Diabetic_ketoacidosis

  Previously considered universally fatal, the risk of death with adequate and timely treatment is between 1% and 5%. […] Up to 1% of children with DKA develop a complication known as cerebral edema. […] Rates of cerebral edema in US children with DKA have risen from 0.4% in 2002 to 0.7% in 2012. […] Between 2 and 5 out of 10 children who develop brain swelling will die as a result.

• #1 Diabetic ketoacidosis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/diabetic-ketoacidosis?lang=us

  Diabetic ketoacidosis is usually associated with type 1 diabetes mellitus but is not uncommon in some patients with type 2 diabetes mellitus. Approximately 30% of children and adolescents with a new diagnosis of type 1 diabetes present with diabetic ketoacidosis at their first presentation. […] The overall mortality rate for diabetic ketoacidosis is 2.5-5% in developed countries.

• #1 Treatment outcomes of diabetic ketoacidosis among diabetes patients in Ethiopia. Hospital-based study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0264626

  Infection, serum glucose fluctuations and severity of DKA were determinants of long hospital stay. […] The present study will determine the treatment outcomes of DKA among patients attending general hospital in North Ethiopia. […] The estimated mean length of hospital stay was around five days. […] Our study revealed that the estimated mean length of hospital stay was around five days. […] The length of hospital stay was affected by age, severity of DKA, number of times serum glucose fluctuations and infections. […] In the present study 4.4% of patients died in the hospital which is almost equal with a finding in Israel 4.1%. […] The high rate of mortality in our study might be due to high prevalence of infection which was approximately 13.2% and treatment complications including hypoglycemia as well as comorbidities. […] The mortality of DKA is unacceptably high with a reported death rate of 26 to 29% in studies from Kenya, Tanzania, and Ghana.

• #1 Burden of diabetic ketoacidosis still unacceptably high, study finds – UNC Gillings School of Global Public Health

  https://sph.unc.edu/sph-news/burden-of-diabetic-ketoacidosis-still-unacceptably-high-study-finds/

  SEARCH for Diabetes in Youth, a multi-center, multi-ethnic study of childhood diabetes, is the largest surveillance effort of diabetes among youth under the age of 20 conducted in the United States to date. […] In a recent study, SEARCH study investigators analyzed data from 5615 youth with Type 1 diabetes and 1425 youth with Type 2 diabetes who were newly diagnosed between 2002 and 2010 to determine levels of diabetic ketoacidosis (DKA). […] The study shows that the frequency of DKA at diagnosis in U.S. youth with Type 1 diabetes did not decline over the last eight years, but remained high compared with other developed countries, with almost a third of all youth with Type 1 diabetes presenting in DKA. […] Rates were disproportionately high in children younger than five years of age, non-white racial/ethnic groups, youth without private health insurance and those with lower family income.

• #1 Active Surveillance Lowers DKA Prevalence at Type 1 Diabetes Diagnosis – Endocrinology Advisor

  https://www.endocrinologyadvisor.com/news/active-surveillance-dka-prevalence-type-1-diabetes-diagnosis/

  Active surveillance and early disease identification were linked to lower prevalence of diabetic ketoacidosis at type 1 diabetes diagnosis among children. […] Despite increasing over time, the prevalence of diabetic ketoacidosis (DKA) decreases with early disease identification and active monitoring, according to study findings published in the Journal of Clinical Endocrinology Metabolism. […] The results of this study highlight the efficacy of early disease identification and active monitoring in lowering DKA prevalence and DKA severity at initial diagnosis. […] The researchers concluded, The results of this study highlight the efficacy of early disease identification and active monitoring in lowering DKA prevalence and DKA severity at initial diagnosis.

• #1 Incidence and prevalence of diabetic ketoacidosis (DKA) among adults with type 1 diabetes mellitus (T1D): a systematic literature review | BMJ Open

  https://bmjopen.bmj.com/content/7/7/e016587

  To our knowledge, this is the first SLR on the epidemiology of DKA in T1D adults. Despite an increasing prevalence of T1D in recent years, DKA in adults has been poorly characterised. In an era when the benefit-risk profiles of new antidiabetic therapies are being evaluated, including the potential risk of DKA, there is a clear need to better elucidate the expected rate of DKA among T1D adults. […] The prevalence of DKA at initial disease presentation in paediatric patients with T1D is well documented; however, information on the prevalence or incidence in adults is limited. One study using the T1D Exchange Clinic Registry in the USA found that 4.8% of participants reported one or more DKA events (requiring self-reported overnight hospitalisation) in the previous 12 months. […] Overall, eight studies reported incidence rate, with a range of 0263 per 1000 PYs, and 11 studies reported prevalence with a range of 0128 per 1000 people. The lowest incidence rates were reported in Israel and North America (both 0 events per 1000 PYs) and the highest in China (263 events per 1000 PYs). The lowest prevalence was reported in Sweden (0 per 1000 people) and the highest in Canada (127.9 per 1000 people).

• #1 Diabetic ketoacidosis among adult patients with diabetes mellitus admitted to emergency unit of Hawassa university comprehensive specialized hospital | BMC Research Notes | Full Text

  https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-019-4186-3

  This study was aimed to assess the prevalence and associated factors of diabetic ketoacidosis among adult patients admitted in emergency department of Hawassa university comprehensive specialized hospital. […] In Ethiopia study shows the prevalence of DKA among acute complication of DM was 68.3% and 71% in Dessie and Jimma respectively. […] DKA is one of the most fatal acute complications among DM patient. Its mortality rate ranges from 2 to 5 percent in developed countries and 6 to 24 percent in developing countries. If it misdiagnosed or mistreated, it is 100% fatal. […] The prevalence of diabetic ketoacidosis among DM patients in this study was 40%. […] In the current study the prevalence of DKA among acute complications of diabetes is 77%. […] The study found that diabetic ketoacidosis is more common in male and young adults particular between the ages of 2534 years.

• #1 Pediatric Diabetic Ketoacidosis (DKA): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/907111-overview

  The prevalence of diabetic ketoacidosis depends largely on geographic location and generally ranges between 13-80% of new-onset type 1 diabetes presentations. […] An estimated one third of children present with diabetic ketoacidosis at diagnosis of type 1 diabetes. […] A multicenter, population-based study reported that around 25% of new cases of type I diabetes mellitus presented with ketoacidosis, resulting in an approximate annual incidence of four cases per 100,000 children. […] The youngest children were at the greatest risk, with more than 37% presenting with diabetic ketoacidosis. […] As in the United States, few data are available on the incidence of diabetic ketoacidosis. […] A large, multicenter European study showed widely varying rates of diabetic ketoacidosis at diagnosis (26-67%), with rates inversely related to the overall incidence of childhood diabetes.

• #1

  https://link.springer.com/article/10.1007/s00125-020-05152-1

  The aim of this work was to evaluate geographical variability and trends in the prevalence of diabetic ketoacidosis (DKA), between 2006 and 2016, at the diagnosis of childhood-onset type 1 diabetes in 13 countries over three continents. […] The overall adjusted DKA prevalence was 29.9%, with the lowest prevalence in Sweden and Denmark and the highest in Luxembourg and Italy. […] DKA prevalence at type 1 diabetes diagnosis varied considerably across countries, albeit it was generally high and showed a slight increase between 2006 and 2016. […] Reported prevalence estimates of DKA at diabetes diagnosis vary between countries and there is some evidence that prevalence is associated with a country’s socioeconomic factors. […] Despite improvements in medical care over the years, and in diabetes care after diabetes onset, the burden of DKA at diagnosis remains high in many countries.

• #1 Trends in Diabetic Ketoacidosis Hospitalizations and In-Hospital Mortality — United States, 2000–2014 | MMWR

  https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a3.htm

  DKA hospitalizations in the United States have increased among all age groups, with the highest rates among persons aged 45 years. Although the continued decline in in-hospital DKA mortality is encouraging, further work might help identify populations at risk. Evidence-based, targeted prevention measures, such as diabetes self-management education and support might help reverse the trend in this potentially life-threatening but avoidable complication of diabetes.

• #1 Colombian multicentric study on epidemiology of diabetic ketoacidosis in children with type 1 diabetes mellitus – MedCrave online

  https://medcraveonline.com/EMIJ/colombian-multicentric-study-on-epidemiology-of-diabetic-ketoacidosis-in-children-with-type-1-diabetes-mellitus.html

  This is an early if not the initial report utilizing a multi center methodology and electronic reporting to collect systematically data about children with T1DM and DKA. […] The primary causes for recurrent DKA in Colombia reflects similar causes in all of our hospital across the Americas and Europe, non-adherence to treatment and intercurrent infections were the main causes for ketoacidosis development in patients. […] This study had a multicentric focus as it included seven participating pediatric intensive care units. All seven units cared for patients both under contributory and subsidized health care, however, only 1.9% of patients with DKA were uninsured; all patients belonged to middle and low socioeconomic classes. It is surprising that, despite having health care coverage, 27.4% of the children did not have the necessary supplies for glycemic control at the time of the decompensations episode; in addition, 94.2% of them did not have access to ketone measurement, which on sick days can help make an early DKA diagnosis leading to an opportune medical consultation.

• #1 Diabetic Ketoacidosis and COVID-19: Two Case Reports – Journal of Occupational Health and Epidemiology

  https://johe.rums.ac.ir/browse.php?a_id=415&sid=1&slc_lang=en&html=1

  On the other hand, COVID-19 can also cause new-onset diabetes with DKA in people with or without known diabetes. […] In this condition, possible causes of DKA include dysfunction of beta cells in the pancreas by COVID-19 virus and interactions between COVID-19 and the angiotensin aldosterone renin (RAAS) system, which increases insulin resistance. […] The severity of DKA is associated with its causes, which, in more than 50% of cases, is due to infections, having more severe manifestations in patients with underlying diabetes. […] Therefore, the possible causes of DKA in these patients might be associated with the medications received for their treatment, including dexamethasone. […] Due to the high prevalence of diabetes mellitus and COVID-19 in Iran, it is recommended to raise awareness of DKA symptoms among health professionals at the time of the pandemic, emphasizing the control of patients’ blood glucose within the normal range, managing the dose of insulin in patients with diabetes, and advising patients to drink fluids and seek medical attention if dehydrated and/or exhibited persistent vomiting.

• #2

  https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2023/06000/comprehensive_review_of_diabetic_ketoacidosis__an.81.aspx

  Diabetic ketoacidosis is the most frequent hyperglycemic emergency. […] Diabetic ketoacidosis is the leading cause of death in people with diabetes mellitus. […] DKA commonly exists in people with type 1 diabetes, and about 3% of type 1 diabetes patients initially present with DKA; the incidence is two episodes per 100 patient-years of diabetes. […] Despite improvements in diabetic patients self-care, DKA still accounts for 14% of all hospital admissions of diabetic patients and 16% of all deaths linked to diabetes. […] Although the incidence of diabetic ketoacidosis in developing nations is unknown, it may be greater than in developed countries. […] The commonest precipitants of diabetic ketoacidosis are poor compliance with insulin therapy, infections, and a new diagnosis of diabetes. […] Diabetic ketoacidosis usually occurs due to absolute or relative insulin lack accompanied by increased glucagon, cortisol, growth hormone, and epinephrine. […] The prognosis of adequately treated patients is excellent.

• #2 Diabetic ketoacidosis epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Diabetic_ketoacidosis_epidemiology_and_demographics

  In 2007, the incidence of diabetic ketoacidosis (DKA) was estimated to be 13 to 26 cases per 100,000 individuals worldwide. […] In the United States, the overall prevalence of diabetic ketoacidosis (DKA) among patients with type 1 diabetes mellitus during 2013-2014 was 3000 individuals per 100,000 patients. […] The annual incidence of diabetic ketoacidosis varies in different reports and is related to the geographic location. […] Worldwide, the annual incidence of diabetic ketoacidosis varies from a low of 13 persons per 100,000 persons (Denmark) to a high of 26 per 100,000 persons (Malaysia). […] Case-fatality rate of DKA varies from a low of less than 1000 per 100,000 individuals (USA and Scotland) to a high of 30,000 per 100,000 individuals (India). […] DKA is the most common cause of death in children and adolescents with type 1 diabetes and accounts for half of all deaths in diabetic patients younger than 24 years of age.

• #2 Lifetime risk and health-care burden of diabetic ketoacidosis: A population-based study

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9449722/

  Diabetic ketoacidosis (DKA) is a life-threatening complication of both type 1 and type 2 diabetes. We aimed to assess population-based rates, trends and outcomes of patients with DKA. […] In total, 5,544 hospitalizations with DKA were identified, of whom 3,847 were seen in patients with type 1 diabetes and 1,697 in type 2 diabetes. Incidence rates of DKA among patients with type 1 diabetes were highest during adolescence with 17.67 (girls) and 13.87 (boys) events per 100,000 person-years and decreased with age in both sexes thereafter. […] The population-based incidence rate of DKA increased over time from 7.22 per 100,000 person-years in 2010 to 9.49 per 100,000 person-years in 2018. […] In type 1 diabetes highest incidence rates of DKA hospitalizations were observed among adolescent females. In comparison, in patients with type 2 diabetes the risk for DKA steadily increased with age with higher rates in adult males.

• #2 Diabetic ketoacidosis – Epidemiology | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/162/epidemiology

  In the US from 2000-2009, the rate of hospitalizations for DKA decreased overall, from 21.9 to 19.5 in 1000 persons with diabetes, but then increased from 2009-2014 to 30.2 in 1000 persons with diabetes. […] In 2014, rates of hospitalization for DKA were highest among people aged 45 years (44.3 in 1000 persons with diabetes) and decreased with age (5.2 in 1000 persons with diabetes aged 45-64 years; 1.6 in 1000 65-74 years; and 1.4 in 1000 75 years). […] From 2000-2014, in-hospital mortality rates among people with DKA consistently decreased, from 1.1% to 0.4%. […] In 2014 in the US, about 207,000 emergency department visits for people aged 18 years were for hyperglycemic crises (e.g., DKA, hyperglycemic hyperosmolar state).

• #2 Lifetime risk and health-care burden of diabetic ketoacidosis: A population-based study

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9449722/

  DKA was associated with a high burden of disease reflected by high rates of intensive care unit admission, prolonged hospital stay and high mortality rates, especially in elderly. […] This population-based cohort study has three key findings: First, while among patients with type 1 diabetes the risk for DKA was highest among adolescents at around 15 years of age, in patients with type 2 diabetes the lifetime risk for DKA steadily increased with age. Second, in adolescence, females were predominantly prone to develop DKA, however in adults there was a switch towards higher rates in males. Third, incidence rates for DKA were increasing over time, especially among the elderly with relevant health-care burden.

• #2 Pediatric Diabetic Ketoacidosis (DKA): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/907111-overview

  The prevalence of diabetic ketoacidosis depends largely on geographic location and generally ranges between 13-80% of new-onset type 1 diabetes presentations. […] An estimated one third of children present with diabetic ketoacidosis at diagnosis of type 1 diabetes. […] A multicenter, population-based study reported that around 25% of new cases of type I diabetes mellitus presented with ketoacidosis, resulting in an approximate annual incidence of four cases per 100,000 children. […] The youngest children were at the greatest risk, with more than 37% presenting with diabetic ketoacidosis. […] As in the United States, few data are available on the incidence of diabetic ketoacidosis. […] A large, multicenter European study showed widely varying rates of diabetic ketoacidosis at diagnosis (26-67%), with rates inversely related to the overall incidence of childhood diabetes.

• #2 Pediatric Diabetic Ketoacidosis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/26827

  In children with an established diagnosis of type 1 diabetes, DKA occurs at an annual rate of 6 to 8%. […] In a large prospective study in the United States, almost 60 percent of DKA episodes in children with established diabetes occurred in only 5 percent of all children. […] Ketosis and DKA can occur less frequently in children with type 2 diabetes and are usually observed mainly in African American adolescents with obesity. About 13 percent had type 2 diabetes in a retrospective review of 69 patients (9 to 18 years of age) who presented with DKA.

• #2 Diabetic Ketoacidosis | Diabetes | CDC

  https://www.cdc.gov/diabetes/about/diabetic-ketoacidosis.html

  Diabetic ketoacidosis (DKA) is serious and can be life-threatening. […] DKA is most common among people with type 1 diabetes. […] DKA is a serious complication of diabetes that can be life-threatening. DKA is most common among people with type 1 diabetes. People with type 2 diabetes can also develop DKA. […] Elevated ketones are a sign of DKA. This is a medical emergency that needs to be treated immediately. […] High ketones can be an early sign of DKA, which is a medical emergency.

• #2 Incidence and prevalence of diabetic ketoacidosis (DKA) among adults with type 1 diabetes mellitus (T1D): a systematic literature review | BMJ Open

  https://bmjopen.bmj.com/content/7/7/e016587

  Objectives To summarise incidence and prevalence of diabetic ketoacidosis (DKA) in adults with type 1 diabetes (T1D) for the overall patient population and different subgroups (age, sex, geographical region, ethnicity and type of insulin administration). […] Results Out of 1082 articles, 19 met the inclusion and exclusion criteria, with two additional studies identified that did not specify the patient age range and are therefore not included in the SLR. Overall, eight studies reported incidence with a range of 056 per 1000 person-years (PYs), with one outlying study reporting an incidence of 263 per 1000 PYs. Eleven studies reported prevalence with a range of 0128 per 1000 people. Prevalence of DKA decreased with increasing age. Subgroup analyses were performed using data from no more than two studies per subgroup. There was a higher prevalence of DKA reported in women, non-whites and patients treated with insulin injections compared with men, whites and patients using continuous subcutaneous insulin infusion pumps, respectively.

• #2 Diabetic Ketoacidosis (DKA) – Oxford Medical Education

  https://oxfordmedicaleducation.com/endocrinology/dka/

  Annual incidence of 1-5% amongst patients with type 1 DM. […] More common in women than men.

• #2 Incidence and determinants of diabetic ketoacidosis among people with diabetes in Woldiya comprehensive specialized hospital, Ethiopia: a retrospective cohort study | BMC Endocrine Disorders | Full Text

  https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-024-01552-1

  Diabetic ketoacidosis is an acute complication of diabetes mellitus that is characterised by hyperglycemia, acidosis, and ketonuria. […] To assess the incidence of Diabetic ketoacidosis and its determinants among adult people with diabetes at an Ethiopian Hospital. […] A total of 121 DKA occurred from 5471 person-months of observation. The overall incidence rate of diabetic ketoacidosis was found to be 2.2 per 100 person-months (95% CI: 1.8- 2.6). […] The overall incidence of diabetic ketoacidosis in study area was relatively high. Poor glycemic control, the presence of infection, and comorbidity were determinants of diabetic ketoacidosis. […] In Ethiopia, incidence of DKA in adult DM patients is unknown, but a study in Hawassa revealed that the prevalence of DKA was about 40%. […] The mortality rate varies from 2 to 5 percent and from 6 to 24 percent for developed and developing countries, respectively.

• #2 Epidemiology of Diabetic Ketoacidosis in National Institute of Diabetes and Endocrinology (NIDE) by:Bassyouni, A.; El Ebrashy, I.; El Hefnawy, H | ICEECE2012 | 15th International & 14th European Congress of Endocrinology | Endocrine Abstracts

  https://www.endocrine-abstracts.org/ea/0029/ea0029p659

  The patients age, weight, blood pressure, pulse, serum creatinin, duration for recovery from DKA, type of DM and presence of coma were associated with mortality in these patients. […] Logestic regression revealed that duration for recovery from DKA was the only independent risk factor for mortality among diabetics with DKA. […] Most of diabetics with DKA are young, females and have type1 DM. […] Non-compliance and infection were the leading precipitating causes for DKA among type1 and type2 respectively. […] Respiratory and urinary tract infections accounted for the majority of infections in these patients. […] Mortality was infrequent finding among our diabetics with DKA. […] Although young age, underweight, tachycardia, hypotension, high serum creatinin, type 2 DM, rapid recovery from DKA and coma were associated with higher mortality rate among patients with DKA, rapid recovery from DKA was the only independent risk factor (predictor) for mortality in these patients.

• #2 Diabetic Ketoacidosis and COVID-19: Two Case Reports – Journal of Occupational Health and Epidemiology

  https://johe.rums.ac.ir/browse.php?a_id=415&sid=1&slc_lang=en&html=1

  Diabetic ketoacidosis (DKA), which can be fatal, is a disorder characterized by metabolic acidosis (pH 7.35 or serum bicarbonate 15 mmol/L), ketonemia or ketonuria, and hyperglycemia (blood glucose 250 mg/dL). […] During the pandemic, several new-onset diabetes with DKA have been reported in COVID-19 patients. […] It seems that the prevalence of DKA due to COVID-19 is increasing; thus, in the present research, two cases of individuals with DKA due to COVID-19 are presented to raise awareness of DKA symptoms among health professionals at the time of the Covid-19 pandemic. […] In this study, two patients with a history of COVID-19 were reported; both were admitted to the hospital with a diagnosis of DKA after a few days. […] The relationship between various infections, such as measles, rubella, EBV, and CMV, with different types of diabetes has been previously identified, proving that DKA, as a complication of diabetes, can be caused by infections.

• #2 Diabetic Ketoacidosis (DKA): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/118361-overview

  Despite advancements in self-care of patients with diabetes, DKA accounts for 14% of all hospital admissions of patients with diabetes and 16% of all diabetes-related fatalities. Almost 50% of diabetes-related admissions in young persons are related to DKA. DKA frequently is observed during the diagnosis of type 1 diabetes and often indicates this diagnosis. While the exact incidence is not known, it is estimated to be 1 out of 2000. […] DKA occurs primarily in patients with type 1 diabetes. The incidence is roughly 2 episodes per 100 patient years of diabetes, with about 3% of patients with type 1 diabetes initially presenting with DKA. It can occur in patients with type 2 diabetes as well; this is less common, however. […] A study by Zhong et al found that in England, for adults with type 1 or type 2 diabetes, there was a growing incidence of hospitalization for DKA between 1998 and 2013. More specifically, the investigators reported that the incidence for patients with type 1 diabetes rose between 1998 and 2007 and then remained at the same level until 2013, while the incidence associated with type 2 diabetes expanded annually by 4.24% between 1998 and 2013.

• #2 Treatment outcomes of diabetic ketoacidosis among diabetes patients in Ethiopia. Hospital-based study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0264626

  Infection, serum glucose fluctuations and severity of DKA were determinants of long hospital stay. […] The present study will determine the treatment outcomes of DKA among patients attending general hospital in North Ethiopia. […] The estimated mean length of hospital stay was around five days. […] Our study revealed that the estimated mean length of hospital stay was around five days. […] The length of hospital stay was affected by age, severity of DKA, number of times serum glucose fluctuations and infections. […] In the present study 4.4% of patients died in the hospital which is almost equal with a finding in Israel 4.1%. […] The high rate of mortality in our study might be due to high prevalence of infection which was approximately 13.2% and treatment complications including hypoglycemia as well as comorbidities. […] The mortality of DKA is unacceptably high with a reported death rate of 26 to 29% in studies from Kenya, Tanzania, and Ghana.

• #2 Diabetic ketoacidosis – WikEM

  https://wikem.org/wiki/Diabetic_ketoacidosis

  Mortality rate approximately 2-5%[1] […] Diagnosis is made based on the presence of acidosis (e.g. venous pH 7.3 or HCO3 18) and ketonemia (e.g. 3mmol/L BOH or ketonuria) in the setting of diabetes (e.g. glucose 200mg/dl)[2]

• #2 Diabetic ketoacidosis among adult patients with diabetes mellitus admitted to emergency unit of Hawassa university comprehensive specialized hospital | BMC Research Notes | Full Text

  https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-019-4186-3

  This study was aimed to assess the prevalence and associated factors of diabetic ketoacidosis among adult patients admitted in emergency department of Hawassa university comprehensive specialized hospital. […] In Ethiopia study shows the prevalence of DKA among acute complication of DM was 68.3% and 71% in Dessie and Jimma respectively. […] DKA is one of the most fatal acute complications among DM patient. Its mortality rate ranges from 2 to 5 percent in developed countries and 6 to 24 percent in developing countries. If it misdiagnosed or mistreated, it is 100% fatal. […] The prevalence of diabetic ketoacidosis among DM patients in this study was 40%. […] In the current study the prevalence of DKA among acute complications of diabetes is 77%. […] The study found that diabetic ketoacidosis is more common in male and young adults particular between the ages of 2534 years.

• #2 Adult Diabetic Ketoacidosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560723/

  However, overall mortality due to hyperglycemic crisis among adults with diabetes has declined in the U.S. Scope for further improvement remains, especially to further reduce death rates among Black men and to prevent deaths occurring at home. […] The geriatric population is at particular risk for developing hyperglycemic crises with the development of diabetes. Some of the causes are increased insulin resistance and a decrease in the thirst mechanism. The elderly are particularly vulnerable to hyperglycemia and dehydration, the critical components of hyperglycemic emergencies. With increased diabetes surveillance and aggressive early treatment of hyperglycemia and its complications, morbidity, and mortality from acute diabetic crises in the geriatric population can be significantly reduced.

• #2

  https://link.springer.com/article/10.1007/s00125-020-05152-1

  The aim of this work was to evaluate geographical variability and trends in the prevalence of diabetic ketoacidosis (DKA), between 2006 and 2016, at the diagnosis of childhood-onset type 1 diabetes in 13 countries over three continents. […] The overall adjusted DKA prevalence was 29.9%, with the lowest prevalence in Sweden and Denmark and the highest in Luxembourg and Italy. […] DKA prevalence at type 1 diabetes diagnosis varied considerably across countries, albeit it was generally high and showed a slight increase between 2006 and 2016. […] Reported prevalence estimates of DKA at diabetes diagnosis vary between countries and there is some evidence that prevalence is associated with a country’s socioeconomic factors. […] Despite improvements in medical care over the years, and in diabetes care after diabetes onset, the burden of DKA at diagnosis remains high in many countries.

• #2 Active Surveillance Lowers DKA Prevalence at Type 1 Diabetes Diagnosis – Endocrinology Advisor

  https://www.endocrinologyadvisor.com/news/active-surveillance-dka-prevalence-type-1-diabetes-diagnosis/

  Active surveillance and early disease identification were linked to lower prevalence of diabetic ketoacidosis at type 1 diabetes diagnosis among children. […] Despite increasing over time, the prevalence of diabetic ketoacidosis (DKA) decreases with early disease identification and active monitoring, according to study findings published in the Journal of Clinical Endocrinology Metabolism. […] The results of this study highlight the efficacy of early disease identification and active monitoring in lowering DKA prevalence and DKA severity at initial diagnosis. […] The researchers concluded, The results of this study highlight the efficacy of early disease identification and active monitoring in lowering DKA prevalence and DKA severity at initial diagnosis.

• #2 Burden of diabetic ketoacidosis still unacceptably high, study finds – UNC Gillings School of Global Public Health

  https://sph.unc.edu/sph-news/burden-of-diabetic-ketoacidosis-still-unacceptably-high-study-finds/

  Among youth with Type 2 diabetes, DKA was much less common and decreased over time, suggesting improved detection or earlier diagnosis of diabetes. […] SEARCH has estimated that there were at least 188,811 youth with diabetes in the U.S. in 2009 168,141 with Type 1 and 19,147 with Type 2. […] In the U.S. and worldwide, the incidence of Type 1 diabetes in youth has been increasing by 3 percent to 4 percent each year, with limited estimates for Type 2 diabetes except in minority populations, in which increased prevalence also has been reported.

• #3

  https://journals.lww.com/tamj/fulltext/2017/45020/epidemiology_of_infection_as_a_precipitating.3.aspx

  Diabetic ketoacidosis (DKA) is one of the life-threatening sequels in diabetes mellitus. Nonadherence to treatment, infections, psychological troubles, and comorbid diseases were the main precipitating factors that trigger DKA. […] Evaluate infection as a precipitating factor of DKA and its correction may contribute to improve outcome and decrease recurrence. […] Infection was the main precipitating factor of DKA (46.5%). The most common source of infections was urinary tract infections and respiratory tract infections (31.2, 26.8%, respectively). […] Infection is the main precipitating factor of DKA in patients of Tanta University Hospital. […] DKA affects more than 8 per 1000 diabetics annually. It is associated with significant morbidity and mortality, with a worldwide mortality rate of 210%.

• #3

  https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2023/06000/comprehensive_review_of_diabetic_ketoacidosis__an.81.aspx

  Diabetic ketoacidosis is the most frequent hyperglycemic emergency. […] Diabetic ketoacidosis is the leading cause of death in people with diabetes mellitus. […] DKA commonly exists in people with type 1 diabetes, and about 3% of type 1 diabetes patients initially present with DKA; the incidence is two episodes per 100 patient-years of diabetes. […] Despite improvements in diabetic patients self-care, DKA still accounts for 14% of all hospital admissions of diabetic patients and 16% of all deaths linked to diabetes. […] Although the incidence of diabetic ketoacidosis in developing nations is unknown, it may be greater than in developed countries. […] The commonest precipitants of diabetic ketoacidosis are poor compliance with insulin therapy, infections, and a new diagnosis of diabetes. […] Diabetic ketoacidosis usually occurs due to absolute or relative insulin lack accompanied by increased glucagon, cortisol, growth hormone, and epinephrine. […] The prognosis of adequately treated patients is excellent.

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