Hyperglycemic Crises in Adult Patients With Diabetes

Abbas E. Kitabchi, PHD, MD; Guillermo E. Umpierrez, MD; John M. Miles, MD; Joseph N. Fisher, MD

Disclosures

Diabetes Care. 2009;32(7):1335-1343. 

In This Article

Epidemiology

Recent epidemiological studies indicate that hospitalizations for DKA in the U.S. are increasing. In the decade from 1996 to 2006, there was a 35% increase in the number of cases, with a total of 136,510 cases with a primary diagnosis of DKA in 2006—a rate of increase perhaps more rapid than the overall increase in the diagnosis of diabetes[1]. Most patients with DKA were between the ages of 18 and 44 years (56%) and 45 and 65 years (24%), with only 18% of patients <20 years of age. Two-thirds of DKA patients were considered to have type 1 diabetes and 34% to have type 2 diabetes; 50% were female, and 45% were nonwhite. 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[5,6]. In adult subjects with DKA, the overall mortality is <1%[1] ; however, a mortality rate >5% has been reported in the elderly and in patients with concomitant life-threatening illnesses[7,8]. Death in these conditions is rarely due to the metabolic complications of hyperglycemia or ketoacidosis but relates to the underlying precipitating illness[4,9]. Mortality attributed to HHS is considerably higher than that attributed to DKA, with recent mortality rates of 5–20%[10,11]. The prognosis of both conditions is substantially worsened at the extremes of age in the presence of coma, hypotension, and severe comorbidities[1,4,8,12,13].

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