Materiały źródłowe

• #1 Understanding and Preventing Diabetic Coma

  https://www.healthline.com/health/understanding-and-preventing-diabetic-coma

  Diabetic coma is a serious, potentially life-threatening complication associated with diabetes. A diabetic coma causes unconsciousness that you cannot awaken from without medical care. Most cases of diabetic coma occur in people with type 1 diabetes. But people with other types of diabetes are also at risk. […] Diabetic comas are considered emergencies that require prompt medical attention and are treated in a hospital setting. […] Diabetic coma is a serious complication that can be fatal. And the odds of death increase the longer you wait for treatment. Waiting too long for treatment can also lead to brain damage. This diabetic complication is rare. But its so serious that all patients must take precautions. […] Diabetic coma is a serious, potentially life-threatening complication associated with diabetes. The power to protect from diabetic coma is in your hands. Know the signs and symptoms that may lead up to a coma, and be prepared to spot problems before they turn into emergencies. Prepare both yourselves and others about what to do if you become comatose. Make sure to manage your diabetes to reduce your risk.

• #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 is common in people with type 1 diabetes. DKA still accounts for 14% of all hospital admissions of diabetic patients and 16% of all deaths linked to diabetes. 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. Although the incidence of diabetic ketoacidosis in developing nations is unknown, it may be greater than in developed countries. Diabetic ketoacidosis usually occurs due to absolute or relative insulin lack accompanied by increased glucagon, cortisol, growth hormone, and epinephrine. This insulin deficiency enhances hepatic gluconeogenesis, glycogenolysis, and lipolysis leading to severe hyperglycemia, ketoacidosis, and ketonuria. […] The most common precipitating factor of diabetic ketoacidosis in type 1 diabetes patients is nonadherence to treatment, while infections are the most common precipitant in type 2 diabetes patients.

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

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

  Epidemiology […] 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. […] 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.

• #4 The epidemiology of diabetic acidosis: a population-based study – PubMed

  https://pubmed.ncbi.nlm.nih.gov/6405612/

  A 12-month epidemiologic study in 1979 and 1980 of all diabetic acidosis admissions to all acute care hospitals in Rhode Island detected 152 episodes occurring in 137 persons. […] Eleven per cent of diabetic acidosis admissions presented in coma and the overall death-to-case ratio was 9%. […] The annual rate of diabetic acidosis was 46 per 10,000 diabetics. […] Highest rates of diabetic acidosis were found for the elderly, those admitted from nursing homes and those residing in one geographic area of the state. […] Infection and noncompliance were the most frequently identified precipitants of diabetic acidosis occurring in known diabetics.

• #5 Epidemiology of acute diabetes complications (coma) according to the Federal Diabetes register of the Russian Federation (2013–2016) | Mayorov | Diabetes mellitus

  https://www.dia-endojournals.ru/jour/article/view/10028?locale=en_US

  Despite the improvement in the quality of diabetes care in the Russian Federation (RF), coma remain one of the causes of death in patients with diabetes. […] In 2016, the prevalence of coma in RF was 225.9 with T1D and 11.6/10000 adults with T2D. […] The frequency of new cases of coma has a tendency to decrease: 0,90,4/10000 adults: T1D 5.73.4, T2D 0.60.2/10000 adults. […] It is established that the dynamics of the frequency of development of coma in 201316 in adult patients with diabetes in the RF has a stable tendency to decrease: 1.5 times with T1D and more than 3 times with T2D. […] Significant interregional differences in the frequency of coma registration require additional analysis.

• #6

  https://journals.mk/aph/article/view/6117

  The highest rate of diabetes-associated complications in North Macedonia are complication on peripheral circulation, followed by ketoacidosis, neurological complications, ophthalmic complication, diabetic coma and multiple complications. […] The calculated burden of diabetes mellitus and diabetic complications in the Republic of North Macedonia amounted to 42,806.59 disability-adjusted life-years (DALYs).

• #7 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. […] The objectives of this SLR were to summarise the available epidemiological data (incidence rate and prevalence) for DKA in adult patients (aged 18 years) with T1D from population-based and other observational studies and to evaluate trends in the evidence for the overall patient population and specific subgroups (age, sex, geography, ethnicity and type of insulin administration such as CSII or multiple daily injections (MDIs)). […] 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.

• #8 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

  The prevalence of DKA decreased with increasing age. […] 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. […] 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). […] 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. […] There is a clear need for future studies to better describe the epidemiology of DKA among adult patients with T1D.

• #9 Epidemiology of infection as a precipitating factor for diabetic ketoacidosis at Tanta University Hospital – Document – Gale OneFile: Health and Medicine

  https://go.gale.com/ps/i.do?id=GALE%7CA511405737&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=11101415&p=HRCA&sw=w

  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). […] DKA affects more than 8 per 1000 diabetics annually. It is associated with significant morbidity and mortality, with a worldwide mortality rate of 2-10%. […] 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. […] Appropriate management of the precipitating factors of DKA decreases the mortality rate and days of hospitalizations.

• #10

  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. […] 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%). […] Infection is the main precipitating factor of DKA in patients of Tanta University Hospital. […] DKA affects more than 8 per 1000 diabetics annually. […] 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%).

• #11 Epidemiological, Clinical, Para-Clinical and Evolutionary Aspects of Diabetic Ketoacidosis At Abass Ndao Hospital

  https://www.scivisionpub.com/articles/epidemiological-clinical-paraclinical-and-evolutionary-aspects-of-diabetic-ketoacidosis-at-abass-ndao-hospital-3038.html

  Diabetic ketoacidosis is a serious complication. It requires appropriate management and therapeutic education of patients. […] The aim of this study was to describe the epidemiological, therapeutic and evolutionary aspects of diabetic ketoacidosis at the Abass ndao hospital in Dakar. […] Diabetic ketoacidosis was 18.94% in our study. […] The average hospital stay was 18.46 days. […] Mortality in our study was 20.97%.

• #12 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 25-34 years.

• #13 Incidence and outcome of adults with diabetic ketoacidosis admitted to ICUs in Australia and New Zealand | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-015-1171-7

  Over the last two decades, there have been several improvements in the management of diabetes. Whether this has impacted on the epidemiology and outcome of diabetic ketoacidosis (DKA) requiring intensive care unit (ICU) admission is unknown. […] The incidence of ICU admission with DKA progressively increased fivefold from 0.97/100,000 (95 % CI 0.841.10) in 2000 to 5.3/100,000 (95 % CI 4.985.53) in 2013 (P0.0001), with the proportions between I and NI remaining stable. […] The incidence of ICU admission of patients with DKA in Australia and New Zealand has increased fivefold over the last decade, with a significant proportion of patients not on insulin at presentation. […] The epidemiology of DKA is variable, and mortality rates range from 2 to 40 % depending on the region. […] Our ICU data demonstrate significant changes in the epidemiology, management and some outcomes of DKA in Australia and New Zealand, with several factors potentially driving such changes.

• #14 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 is a life-threatening but avoidable complication of diabetes. Prevention measures, such as diabetes self-management education, might help reverse the increasing trend in DKA, especially in persons aged 45 years who have the highest DKA rates. […] CDC’s United States Diabetes Surveillance System (USDSS) indicated an increase in hospitalization rates for DKA during 2009-2014, most notably in persons aged 45 years.

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

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

  Overall, age-adjusted DKA hospitalization rates decreased slightly from 2000 to 2009, then reversed direction, steadily increasing from 2009 to 2014 at an average annual rate of 6.3%. In-hospital case-fatality rates declined consistently during the study period from 1.1% to 0.4%. […] 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.

• #16 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. […] 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.

• #17 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.

• #18 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.

• #19 Diabetic Ketoacidosis: Symptoms and Treatment | Doctor

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

  How common is diabetic ketoacidosis? (Epidemiology) 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. […] To reduce the risk of catastrophic outcomes in adults with DKA, ensure that monitoring is continuous and that review covers all aspects of clinical management at frequent intervals.

• #20 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. […] Mortality rate greater than 5% has been reported in the elderly and patients with concomitant life-threatening illnesses. Death in these conditions is rarely because of the metabolic complications of hyperglycemia or ketoacidosis alone.

• #21 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. […] The study, published in the April issue of the journal Pediatrics and led by Dana Dabelea, MD, PhD, professor and associate dean at the University of Colorado School of Public Health, 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. […] Among youth with Type 2 diabetes, DKA was much less common and decreased over time, suggesting improved detection or earlier diagnosis of diabetes.

• #22 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. […] 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. […] 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%). […] 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. […] 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.

• #23 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 was defined as plasma glucose 250 mg/dL, a positive test for urine ketones, and arterial pH 7.35. […] 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. […] The role of some disorders, such as diabetes, obesity, and cardiovascular, has already been identified as an aggravating factor in infectious diseases, especially COVID-19. […] COVID-19 can also cause new-onset diabetes with DKA in people with or without known diabetes. […] 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.

• #24 Teens May Self-induce Diabetic Coma

  https://www.pharmacytimes.com/view/2006-04-5390

  Patients with diabetes need to be aware that excess insulin can lower blood sugar levels too far, which can lead to a coma in severe cases. […] Paris researchers found that recurrent episodes of hypoglycemic coma among teens may be a warning of deliberate self-administration of large doses of insulin. […] The study’s findings indicated 19 patients with a very unusual frequency of coma. […] Of these patients, 16 admitted to secret self-administration of insulin at the time of the event or several years later. […] Seven patients confessed to using insulin to deliberately induce coma. […] Another 5 adolescents injected secretive doses of insulin, apparently in reaction to parental pressure to lower blood sugar levels because of unreasonable fears of future blindness. […] The findings were reported in Diabetes Care, February 2006.

• #25 Diabetic coma // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/diabetic-coma

  A diabetic coma is a life-threatening disorder that causes unconsciousness. If you have diabetes, dangerously high blood sugar (hyperglycemia) or dangerously low blood sugar (hypoglycemia) can lead to a diabetic coma. […] A diabetic coma is a medical emergency. If you have symptoms of high or low blood sugar and you think you might pass out, call 911 or your local emergency number. […] Blood sugar that’s either too high or too low for too long may cause the following serious health problems, all of which can lead to a diabetic coma. […] If it is not treated, a diabetic coma can lead to permanent brain damage and death. […] Good day-to-day control of your diabetes can help you prevent a diabetic coma. […] Diabetic coma requires emergency medical treatment. The type of treatment depends on whether your blood sugar level is too high or too low.

• #26 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.

• #27 Adult Diabetic Ketoacidosis – StatPearls – NCBI Bookshelf

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

  The prognosis substantially worsens at the extremes of age in the presence of coma, hypotension, and severe comorbidities. […] 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. […] 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.

• #28 Profile of Diabetic Omani Pilgrims to Makkah | Field Epidemiology Training Program

  https://www.saudifetp.org/seb/profile-diabetic-omani-pilgrims-makkah

  The annual pilgrimage to Makkah (Mecca), Hajj, is stressful, especially for diabetics, elderly, and others with chronic illnesses. […] To identify diabetic complications and to assess the needs of the Omani diabetics during Hajj (DOH), the Field Epidemiology Training Program established a special diabetes clinic for Omani Hajjees in Mina. […] An estimated 100,000-150,000 diabetics perform Hajj every year. During the period between 1992 and 1995, diabetic coma accounted for 0.7-2.1% of all deaths that occur during Hajj. […] Diabetes mellitus is a known risk factor for other illnesses that require hospitalization e.g., chest infections. […] It is disturbing that only one fourth of DOH recognized symptoms of hypoglycemia, and 70% did not wear identification wrist bands, recommended by Hajj health authorities, that show their diabetic status and regimen for treatment in case of emergencies. […] Nevertheless, there is deficiency of studies about DM and Hajj, a gap in literature that invites more work to identify risk factors for complications among diabetic Hajjees, and appropriate interventions.

• #29 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

  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.

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