Clinical profile of diabetic ketoacidosis in tertiary hospitals in China: A multicentre, clinic-based study

Y. Xu, J. Bai, G. Wang, S. Zhong, X. Su, Z. Huang, G. Chen, J. Zhang, X. Hou, X. Yu, B. Lu, Y. Wang, X. Li, H. Hu, C. Zhang, Y. Liang, J. Shaw, X. Wu

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Abstract

Aims: To evaluate the clinical profile of patients with diabetic ketoacidosis in tertiary hospitals in China. Methods: A retrospective study of patients hospitalized with diabetic ketoacidosis between 2010 and 2012 was carried out in 15 tertiary hospitals around China. Clinical and laboratory data were collected. Patients were classified based on clinical diagnosis and treatment history. Groups were compared for differences in vital statistics and biochemical profiles at presentation. Results: The study comprised 643 patients with diabetic ketoacidosis: 308 patients (47.9%) with Type 1 diabetes, 294 patients (45.7%) with Type 2 diabetes and 41 patients (6.4%) with atypical diabetes. Three hundred and eighty-eight diabetic ketoacidosis episodes (60.3%) were in patients with known diabetes. The most common precipitating factor was infection (40.1%), followed by unknown causes (36.9%) and non-compliance with anti-diabetes treatment (16.8%). At presentation, gastrointestinal symptoms and dehydration were more common in the Type 1 diabetes group. For new-onset diabetes, only 74.4% and 55.9% of patients were evaluated for β-cell function and autoantibodies for classification. Only 67% of patients with diabetic ketoacidosis received appropriate fluid therapy and 56% patients with severe acidosis received bicarbonate therapy. The length of hospital stay was 10.0 (7.0-14.0) days. The mortality rate was 1.7%, and was much higher in Type 2 diabetes than that in Type 1 diabetes (3.2% vs. 0.4%, P < 0.01). Conclusions: Type 2 and Type 1 diabetes contribute to a similar proportion of cases presenting with diabetic ketoacidosis in China. Admissions with diabetic ketoacidosis are still associated with significant mortality and prolonged hospitalization. The efficiency of diabetic ketoacidosis management needs to be improved by implementing the updated guidelines.

Original languageEnglish
Pages (from-to)261-268
Number of pages8
JournalDiabetic Medicine
Volume33
Issue number2
DOIs
Publication statusPublished - 1 Feb 2016
Externally publishedYes

Cite this

Xu, Y. ; Bai, J. ; Wang, G. ; Zhong, S. ; Su, X. ; Huang, Z. ; Chen, G. ; Zhang, J. ; Hou, X. ; Yu, X. ; Lu, B. ; Wang, Y. ; Li, X. ; Hu, H. ; Zhang, C. ; Liang, Y. ; Shaw, J. ; Wu, X. / Clinical profile of diabetic ketoacidosis in tertiary hospitals in China : A multicentre, clinic-based study. In: Diabetic Medicine. 2016 ; Vol. 33, No. 2. pp. 261-268.
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title = "Clinical profile of diabetic ketoacidosis in tertiary hospitals in China: A multicentre, clinic-based study",
abstract = "Aims: To evaluate the clinical profile of patients with diabetic ketoacidosis in tertiary hospitals in China. Methods: A retrospective study of patients hospitalized with diabetic ketoacidosis between 2010 and 2012 was carried out in 15 tertiary hospitals around China. Clinical and laboratory data were collected. Patients were classified based on clinical diagnosis and treatment history. Groups were compared for differences in vital statistics and biochemical profiles at presentation. Results: The study comprised 643 patients with diabetic ketoacidosis: 308 patients (47.9{\%}) with Type 1 diabetes, 294 patients (45.7{\%}) with Type 2 diabetes and 41 patients (6.4{\%}) with atypical diabetes. Three hundred and eighty-eight diabetic ketoacidosis episodes (60.3{\%}) were in patients with known diabetes. The most common precipitating factor was infection (40.1{\%}), followed by unknown causes (36.9{\%}) and non-compliance with anti-diabetes treatment (16.8{\%}). At presentation, gastrointestinal symptoms and dehydration were more common in the Type 1 diabetes group. For new-onset diabetes, only 74.4{\%} and 55.9{\%} of patients were evaluated for β-cell function and autoantibodies for classification. Only 67{\%} of patients with diabetic ketoacidosis received appropriate fluid therapy and 56{\%} patients with severe acidosis received bicarbonate therapy. The length of hospital stay was 10.0 (7.0-14.0) days. The mortality rate was 1.7{\%}, and was much higher in Type 2 diabetes than that in Type 1 diabetes (3.2{\%} vs. 0.4{\%}, P < 0.01). Conclusions: Type 2 and Type 1 diabetes contribute to a similar proportion of cases presenting with diabetic ketoacidosis in China. Admissions with diabetic ketoacidosis are still associated with significant mortality and prolonged hospitalization. The efficiency of diabetic ketoacidosis management needs to be improved by implementing the updated guidelines.",
author = "Y. Xu and J. Bai and G. Wang and S. Zhong and X. Su and Z. Huang and G. Chen and J. Zhang and X. Hou and X. Yu and B. Lu and Y. Wang and X. Li and H. Hu and C. Zhang and Y. Liang and J. Shaw and X. Wu",
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Xu, Y, Bai, J, Wang, G, Zhong, S, Su, X, Huang, Z, Chen, G, Zhang, J, Hou, X, Yu, X, Lu, B, Wang, Y, Li, X, Hu, H, Zhang, C, Liang, Y, Shaw, J & Wu, X 2016, 'Clinical profile of diabetic ketoacidosis in tertiary hospitals in China: A multicentre, clinic-based study' Diabetic Medicine, vol. 33, no. 2, pp. 261-268. https://doi.org/10.1111/dme.12820

Clinical profile of diabetic ketoacidosis in tertiary hospitals in China : A multicentre, clinic-based study. / Xu, Y.; Bai, J.; Wang, G.; Zhong, S.; Su, X.; Huang, Z.; Chen, G.; Zhang, J.; Hou, X.; Yu, X.; Lu, B.; Wang, Y.; Li, X.; Hu, H.; Zhang, C.; Liang, Y.; Shaw, J.; Wu, X.

In: Diabetic Medicine, Vol. 33, No. 2, 01.02.2016, p. 261-268.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Clinical profile of diabetic ketoacidosis in tertiary hospitals in China

T2 - A multicentre, clinic-based study

AU - Xu, Y.

AU - Bai, J.

AU - Wang, G.

AU - Zhong, S.

AU - Su, X.

AU - Huang, Z.

AU - Chen, G.

AU - Zhang, J.

AU - Hou, X.

AU - Yu, X.

AU - Lu, B.

AU - Wang, Y.

AU - Li, X.

AU - Hu, H.

AU - Zhang, C.

AU - Liang, Y.

AU - Shaw, J.

AU - Wu, X.

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Aims: To evaluate the clinical profile of patients with diabetic ketoacidosis in tertiary hospitals in China. Methods: A retrospective study of patients hospitalized with diabetic ketoacidosis between 2010 and 2012 was carried out in 15 tertiary hospitals around China. Clinical and laboratory data were collected. Patients were classified based on clinical diagnosis and treatment history. Groups were compared for differences in vital statistics and biochemical profiles at presentation. Results: The study comprised 643 patients with diabetic ketoacidosis: 308 patients (47.9%) with Type 1 diabetes, 294 patients (45.7%) with Type 2 diabetes and 41 patients (6.4%) with atypical diabetes. Three hundred and eighty-eight diabetic ketoacidosis episodes (60.3%) were in patients with known diabetes. The most common precipitating factor was infection (40.1%), followed by unknown causes (36.9%) and non-compliance with anti-diabetes treatment (16.8%). At presentation, gastrointestinal symptoms and dehydration were more common in the Type 1 diabetes group. For new-onset diabetes, only 74.4% and 55.9% of patients were evaluated for β-cell function and autoantibodies for classification. Only 67% of patients with diabetic ketoacidosis received appropriate fluid therapy and 56% patients with severe acidosis received bicarbonate therapy. The length of hospital stay was 10.0 (7.0-14.0) days. The mortality rate was 1.7%, and was much higher in Type 2 diabetes than that in Type 1 diabetes (3.2% vs. 0.4%, P < 0.01). Conclusions: Type 2 and Type 1 diabetes contribute to a similar proportion of cases presenting with diabetic ketoacidosis in China. Admissions with diabetic ketoacidosis are still associated with significant mortality and prolonged hospitalization. The efficiency of diabetic ketoacidosis management needs to be improved by implementing the updated guidelines.

AB - Aims: To evaluate the clinical profile of patients with diabetic ketoacidosis in tertiary hospitals in China. Methods: A retrospective study of patients hospitalized with diabetic ketoacidosis between 2010 and 2012 was carried out in 15 tertiary hospitals around China. Clinical and laboratory data were collected. Patients were classified based on clinical diagnosis and treatment history. Groups were compared for differences in vital statistics and biochemical profiles at presentation. Results: The study comprised 643 patients with diabetic ketoacidosis: 308 patients (47.9%) with Type 1 diabetes, 294 patients (45.7%) with Type 2 diabetes and 41 patients (6.4%) with atypical diabetes. Three hundred and eighty-eight diabetic ketoacidosis episodes (60.3%) were in patients with known diabetes. The most common precipitating factor was infection (40.1%), followed by unknown causes (36.9%) and non-compliance with anti-diabetes treatment (16.8%). At presentation, gastrointestinal symptoms and dehydration were more common in the Type 1 diabetes group. For new-onset diabetes, only 74.4% and 55.9% of patients were evaluated for β-cell function and autoantibodies for classification. Only 67% of patients with diabetic ketoacidosis received appropriate fluid therapy and 56% patients with severe acidosis received bicarbonate therapy. The length of hospital stay was 10.0 (7.0-14.0) days. The mortality rate was 1.7%, and was much higher in Type 2 diabetes than that in Type 1 diabetes (3.2% vs. 0.4%, P < 0.01). Conclusions: Type 2 and Type 1 diabetes contribute to a similar proportion of cases presenting with diabetic ketoacidosis in China. Admissions with diabetic ketoacidosis are still associated with significant mortality and prolonged hospitalization. The efficiency of diabetic ketoacidosis management needs to be improved by implementing the updated guidelines.

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U2 - 10.1111/dme.12820

DO - 10.1111/dme.12820

M3 - Article

VL - 33

SP - 261

EP - 268

JO - Diabetic Medicine

JF - Diabetic Medicine

SN - 0742-3071

IS - 2

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