Background – Diabetic ketoacidosis (DKA) is a hyperglycaemic emergency classically associated with type 1 diabetes (T1D) but has been increasingly recognised in patients with non-T1D. This study aimed to describe patient characteristics and diabetes type in patients presenting with DKA at the Royal Melbourne Hospital.
Methods – We performed a retrospective analysis of all patients with a discharge code of DKA as primary diagnosis between July 2011 and June 2016. We excluded three patients who were outliers with multiple representations. Files were reviewed and all patients who satisfied DKA criteria (pH <7.3, capillary ketones >2mmol/L, and blood glucose [BG] >15mmol/L) were included. Diabetes characteristics including treatment regimen, antibody status, beta cell function and biochemistry at the time of presentation were analysed.
Results – Of the 278 discharges coded with DKA as primary diagnosis, 175 (63%) satisfied biochemical criteria. Of these, 143 (82%) had classical T1D, 15 (9%) had latent autoimmune diabetes in adults (LADA), 11 (6%) had type 2 diabetes (T2D), and 6 (3%) had other forms of diabetes. The HbA1c of this cohort was 11.3±2.3% (100±25 mmol/mol). Nineteen patients (11%) had a new diagnosis of diabetes, 13 (7%) were on insulin pumps. In 34 (20%) the DKA was severe with pH<7.0.
Compared to T1D (classical T1D and LADA), patients with T2D had higher presenting glucose (42.9 vs. 31.0 mmol/L, p=0.04); higher pH (7.22 vs. 7.13, p=0.001); and longer median length of stay (6 vs. 2 days, p<0.001). In patients without T1D, the random c-peptide was 0.28 [0.08-0.81] nmol/L (median [IQR]).
Conclusion – This study found that 9% of patients presenting with DKA do not have T1D. T2D patients with DKA tend to have higher plasma glucose and milder acidosis at presentation but longer length of stay.