Incidence of diabetic ketoacidosis in patients with type 2 diabetes

Abstract

Dijabetička ketoacidoza je jedna od najopasnijih akutnih komplikacija šećerne bolesti te može rezultirati visokom stopom smrtnosti ako nije odgovarajuće ili na vrijeme liječena. Glavni uzrok ovog stanja su nedostatak inzulina i povišene razine protu-regulatornih hormona (glukagona, hormona rasta, katekolamina i kortizola). Do nedavno se smatralo da je ketoacidoza gotovo isključivo vezana uz tip 1 šećerne bolesti, ali sve više istraživanja prikazuju njenu prisutnost u tipu 2 šećerne bolesti. Cilj ovog istraživanja je bio odrediti učestalost i moguće razloge nastanka ketoacidoze u bolesnika sa šećernom bolešću tipa 2. Istraživanje je uključivalo pretraživanje baze podataka Kliničke bolnice Dubrava u razdoblju od 1. srpnja 2010. godine do 1. srpnja 2015. godine te analizu podataka o kliničkom profilu pacijenata. Kod novodijagnosticiranih bolesnika odredila se koncentracija glukoze u krvi, acidobazni status te vrijednosti glikiranog hemoglobina. Od 72 pacijenta, njih 27 (37.2%) imalo je tip 1 šećerne bolesti i 45 (62.5%) tip 2 šećerne bolesti. U skupini pacijenata sa šećernom bolešću tipa 1, osam pacijenata (27.5%) su imala epizodu ketoacidoze kao prvi znak šećerne bolesti, dok je u skupini bolesnika sa šećernom bolešću tipa 2, trinaest pacijenata (28.8%) imalo je dijabetičku ketoacidozu kao prvi znak šećerne bolesti. Nepridržavanje terapije i infekcije bili su najčešći uzroci ketoacidoze.Diabetic ketoacidosis is one of the most dangerous acute complications of diabetes, responsible for significant mortality if not treated properly and on time. The main features of this condition are insulin deficiency and increased levels of counter-regulatory hormones (glucagon, growth hormone, catecholamines and cortisol). Until recently it was thought that ketoacidosis is present only in type 1 diabetes, but more studies reported its presence in type 2 diabetes. Aim of this study was to establish the frequency and precipitating factors for the occurrence of diabetic ketoacidosis in patients with type 2 diabetes. The research involved searching data bases in the period from July 1st 2010 until July 1st 2015 and clinical profile of patients were analyzed. In newly diagnosed patients, concentration of blood glucose, acid-base status and the values of glycated hemoglobin were determined. Out of 72 patients, 27 (37.2%) had type 1 and 45 (62.5%) had type 2 diabetes. Among patients with type 1 diabetes, 8 (27.5%) patients had an episode of ketoacidosis as the initial case of diabetes, whereas among patients with type 2, 13 (28.8%) patients had mentioned complication as a first sign of disease. Non-compliance to treatment and infection were the most common causes of ketoacidosis