Vol 5, No 1 (2020)
Review paper
Published online: 2020-01-13

open access

Page views 668
Article views/downloads 676
Get Citation

Connect on Social Media

Connect on Social Media

Emergency medicine point of view on epidemiology of diabetes and diabetes-related complications

Patrycja Szalast1, Lukasz Szarpak1
Disaster Emerg Med J 2020;5(1):41-48.


Despite centuries of research and clinical work, the diagnosis of diabetes was still treated as a quick death sentence at the beginning of the 20th century. Unfortunately, the number of patients with diabetes is increasing every year. Type 2 diabetes is increasingly common among young people: children and adolescents. The article discusses the type of diabetes and the importance of rapid diagnosis and management. Type 1 diabetes, type 2 diabetes, latent autoimmune diabetes in adults, monogenic diabetes, gestational diabetes was analyzed. Life threatening conditions resulting from complications of diabetes including diabetic ketoacidosis, hyperglycemic hyperosmolar state, hypoglycemia, lactic acidosis was discussed, and the first-line emergency treatment were analyzed. The life-threatening complications of diabetes and rescue procedures in these conditions were discussed in detail. Conclusion. Due to the frequency of life-threatening complications, diabetes is a heavy burden on the medical staff. Adequate diagnosis and implementation of appropriate treatment significantly improve the patient's condition.

Article available in PDF format

View PDF Download PDF file


  1. Tuchman AM. History of diabetes. MD Advis. 2013; 6(1): 8–13.
  2. Maahs DM, West NA, Lawrence JM, et al. Epidemiology of type 1 diabetes. Endocrinol Metab Clin North Am. 2010; 39(3): 481–497.
  3. de Ferranti SD, de Boer IH, Fonseca V, et al. Type 1 diabetes mellitus and cardiovascular disease: a scientific statement from the American Heart Association and American Diabetes Association. Circulation. 2014; 130(13): 1110–1130.
  4. Pozzilli P, Pieralice S. Latent Autoimmune Diabetes in Adults: Current Status and New Horizons. Endocrinol Metab (Seoul). 2018; 33(2): 147–159.
  5. Li Q, Qiao ZR, Liu DB, et al. Relationship between serum GAD-Ab and the genetic polymorphisms of GAD2 and type 2 diabetes mellitus. Genet Mol Res. 2015; 14(2): 3002–3009.
  6. Suzuki R. T-cell function in anti-GAD65+diabetes with residual β-cell function. Journal of Autoimmunity. 2003; 20(1): 83–90.
  7. Becerril Ángeles M, García Lara SE, González Bárcena D, et al. [Autoantibodies in GAD65 in Mexican adults with diabetes types 1 and 2 and their siblings]. Rev Alerg Mex. 2010; 57(6): 190–195.
  8. Moloney TC, Idris I, Waters P, et al. Autoantibodies to glutamic acid decarboxylase in patients with epilepsy and their relationship with type 1 diabetes: a pilot study. J Neurol Neurosurg Psychiatry. 2016; 87(6): 676–677.
  9. Harris AG, Letourneau LR, Greeley SA. Monogenic diabetes: the impact of making the right diagnosis. Curr Opin Pediatr. 2018; 30(4): 558–567.
  10. Sanyoura M, Philipson LH, Naylor R. Monogenic Diabetes in Children and Adolescents: Recognition and Treatment Options. Curr Diab Rep. 2018; 18(8): 58.
  11. Mishra R, Hodge KM, Cousminer DL, et al. A Global Perspective of Latent Autoimmune Diabetes in Adults. Trends Endocrinol Metab. 2018; 29(9): 638–650.
  12. DeFronzo RA. Pathogenesis of type 2 diabetes mellitus. Med Clin North Am. 2004; 88(4): 787–835, ix.
  13. Yazdanpanah S, Rabiee M, Tahriri M, et al. Evaluation of glycated albumin (GA) and GA/HbA1c ratio for diagnosis of diabetes and glycemic control: A comprehensive review. Crit Rev Clin Lab Sci. 2017; 54(4): 219–232.
  14. Fletcher B, Gulanick M, Lamendola C. Risk factors for type 2 diabetes mellitus. J Cardiovasc Nurs. 2002; 16(2): 17–23.
  15. Whitmore C. Type 2 diabetes and obesity in adults. Br J Nurs. 2010; 19(14): 880, 882–880, 886.
  16. Caruso R, Magon A, Baroni I, et al. Health literacy in type 2 diabetes patients: a systematic review of systematic reviews. Acta Diabetol. 2018; 55(1): 1–12.
  17. Chiefari E, Arcidiacono B, Foti D, et al. Gestational diabetes mellitus: an updated overview. J Endocrinol Invest. 2017; 40(9): 899–909.
  18. Ananthakrishnan S. Diabetes insipidus during pregnancy. Best Practice & Research Clinical Endocrinology & Metabolism. 2016; 30(2): 305–315.
  19. Stoner GD, Stoner GD. Hyperosmolar hyperglycemic state. Am Fam Physician. 2005; 71(9): 1723–1730.
  20. Scott AR. Joint British Diabetes Societies (JBDS) for Inpatient Care, JBDS hyperosmolar hyperglycaemic guidelines group. Management of hyperosmolar hyperglycaemic state in adults with diabetes. Diabet Med. 2015; 32(6): 714–724.
  21. Fayfman M, Pasquel FJ, Umpierrez GE. Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State. Med Clin North Am. 2017; 101(3): 587–606.
  22. Frank LA, Solomon A. Hyperglycaemic hyperosmolar state. Br J Hosp Med (Lond). 2016; 77(9): C130–C133.
  23. Yared Z, Chiasson JL. Ketoacidosis and the hyperosmolar hyperglycemic state in adult diabetic patients. Diagnosis and treatment. Minerva Med. 2003; 94(6): 409–418.
  24. Umpierrez G, Korytkowski M. Diabetic emergencies — ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nat Rev Endocrinol. 2016; 12(4): 222–232.
  25. Giménez-Cassina A, Garcia-Haro L, Choi CS, et al. Regulation of hepatic energy metabolism and gluconeogenesis by BAD. Cell Metab. 2014; 19(2): 272–284.
  26. Workgroup on Hypoglycemia, American Diabetes Association. Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia. Diabetes Care. 2005; 28(5): 1245–1249.
  27. Ebadi SA, Darvish P, Fard AJ, et al. Hypoglycemia and cognitive function in diabetic patients. Diabetes Metab Syndr. 2018; 12(6): 893–896.
  28. Rossi MC, Nicolucci A, Ozzello A, et al. HYPOS-1 Study Group of AMD. Impact of severe and symptomatic hypoglycemia on quality of life and fear of hypoglycemia in type 1 and type 2 diabetes. Results of the Hypos-1 observational study. Nutr Metab Cardiovasc Dis. 2019; 29(7): 736–743.
  29. Musen G, Jacobson AM, Ryan CM, et al. Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Impact of diabetes and its treatment on cognitive function among adolescents who participated in the Diabetes Control and Complications Trial. Diabetes Care. 2008; 31(10): 1933–1938.
  30. Shaefer C, Hinnen D, Sadler C. Hypoglycemia and diabetes: increased need for awareness. Curr Med Res Opin. 2016; 32(9): 1479–1486.
  31. Lee YH, Wang MY, Yu XX, et al. Glucagon is the key factor in the development of diabetes. Diabetologia. 2016; 59(7): 1372–1375.
  32. Williams KM, Fazzio P, Oberfield SE, et al. Cortisol Levels in Children With Diabetic Ketoacidosis Associated With New-Onset Type 1 Diabetes Mellitus. Clin Pediatr (Phila). 2017; 56(2): 117–122.
  33. Feldman JM, Plonk JW, Bivens CH. The role of cortisol and growth hormone in the counter-regulation of insulin-induced hypoglycemia. Horm Metab Res. 1975; 7(5): 378–381.
  34. Thulé PM, Umpierrez G. Sulfonylureas: a new look at old therapy. Curr Diab Rep. 2014; 14(4): 473.
  35. Arky RA. Hypoglycemia associated with liver disease and ethanol. Endocrinol Metab Clin North Am. 1989; 18(1): 75–90.
  36. Claudino WM, Dias A, Tse W, et al. Type B lactic acidosis: a rare but life threatening hematologic emergency. A case illustration and brief review. Am J Blood Res. 2015; 5(1): 25–29.
  37. Rüegg T, Caduff B. Accumulation of Metformin-associated Lactic Acidosis. Dtsch Med Wochenschr. 2017; 142(6): 428–431.
  38. Hevesy MR. Metformin-Associated Lactic Acidosis: An Atypical Presentation. Adv Emerg Nurs J. 2017; 39(1): 26–30.
  39. Rubin RP. Carl and Gerty Cori: A collaboration that changed the face of biochemistry. J Med Biogr. 2019 [Epub ahead of print]: 967772019866954.
  40. Moioli A, Maresca B, Manzione A, et al. Metformin associated lactic acidosis (MALA): clinical profiling and management. J Nephrol. 2016; 29(6): 783–789.
  41. Bianchetti DG, Amelio GS, Lava SAG, et al. D-lactic acidosis in humans: systematic literature review. Pediatr Nephrol. 2018; 33(4): 673–681.
  42. Schuh AM, Leger KJ, Summers C, et al. Lactic Acidosis in a Critically Ill Patient: Not Always Sepsis. Pediatr Emerg Care. 2018; 34(9): e165–e167.
  43. Halperin ML. Lactic acidosis and ketoacidosis: biochemical and clinical implications. Can Med Assoc J. 1977; 116(9): 1034–1038.

Disaster and Emergency Medicine Journal