Analysis of causative factors of diabetic ketoacidosis in adult patients with type 1 diabetes

Abstract

Introduction. Diabetic ketoacidosis (DKA) results from absolute insulin deficiency. Delayed diagnosis or inadequate treatment of DKA may lead to coma or death. The aim of this study was to determine the exact DKA causative factors in patients with type 1 diabetes (DM1) hospitalized at the Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences.

Material and methods. We performed a retrospective analysis of medical records of 103 diabetic ketoacidosis in patients treated between November 2008 and March 2011. The analysis included only adult patients with type 1 diabetes and documented treatment of DKA. Incidence of causative factors of DKA was studied among all patients hospitalized due to DKA and inpatients with previously diagnosed DM1. Additionally, the frequency of various causes of DKA, depending on the insulin therapy regimen was established.

Results. In 47.6% of all analysed cases, DKA was caused by insulin omission, in 41.8% by infection andin 24.3% by delayed diagnosis of type 1 diabetes. Inpatients with previously diagnosed DM1, in 62.8% of cases DKA resulted from insulin omission and in 55.1% from infections. Among the patients on insulin pump therapy, 81.8% of DKA episodes developed as a result of insulin pump occlusion and 54.5% were triggered by infections. In patients on intensive insulin therapy using injecting devices (pens), 70.0% of DKA cases were caused by errors in insulin therapy and 43.3% byinfections. In 68.8% of patients using premixed insulin, precipitating factor for DKA was infection and in 56.3% — in correct insulin dosing. Recurrent DKA was associated with insulin omission in 76.2% of cases and infection in 52.4%.

Conclusion. In every fourth patient hospitalized due to diabetic ketoacidosis, metabolic disturbances were a consequence of delayed diagnosis of type 1 diabetes. In patients with previously diagnosed type 1 diabetes, the leading cause of diabetic ketoacidosis, regardless of insulin therapy regimen, were insulin omission and infections. The main cause of recurrent diabetic ketoacidosis was non-compliance with insulin therapy.