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Acta medica Croatica : Časopis Akademije medicinskih znanosti Hrvatske, Vol. 76 No. 4, 2022.

Original scientific paper

PRECIPITATING FACTORS AND CLINICAL FEATURES OF DIABETIC KETOACIDOSIS

NINO MATAS ; Department of General Medicine, Dubrovnik General Hospital, Dubrovnik, Croatia
ANJA BARAČ NEKIĆ orcid id orcid.org/0000-0003-2672-8529 ; Department of Endocrinology, Zagreb University Hospital Center, Zagreb, Croatia
SANJA MLINARIĆ VRBICA orcid id orcid.org/0000-0003-2575-7918 ; Department of General Medicine, Dubrovnik General Hospital, Dubrovnik, Croatia
ANELA NOVAK orcid id orcid.org/0000-0003-2575-7918 ; Department of Endocrinology, Diabetology and Metabolic Diseases,Split University Hospital Center,Split, Croatia; School of Medicine, University of Split, Split, Croatia
TATJANA BAČUN ; Faculty of Medicine in Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; Department of Endocrinology, Osijek University Hospital Center, Osijek, Croatia
IVAN FELDI orcid id orcid.org/0000-0001-6310-2205 ; Department of General Medicine, Našice General Hospital, Našice, Croatia
SVETOLIK SPASIĆ orcid id orcid.org/0000-0002-5352-8998 ; Ljubodrag Buba Mihailović Institute of Pathologic Physiology, Medical Faculty, Belgrade, Serbia
ANTONELA ČOLIĆ orcid id orcid.org/0009-0007-0581-1071 ; Department of Emergency Medicine of Dubrovnik-Neretva County, Orebić, Croatia
FRAN VRANDEČIĆ ; Zagreb-East Health Center, Zagreb, Croatia
KARIN ZIBAR TOMŠIĆ orcid id orcid.org/0000-0002-1694-6891 ; Department of Endocrinology, Zagreb University Hospital Center, Zagreb, Croatia
DARKO KAŠTELAN orcid id orcid.org/0000-0003-3034-5598 ; Department of Endocrinology, Zagreb University Hospital Center, Zagreb, Croatia;School of Medicine, University of Zagreb, Zagreb, Croatia
TINA DUŠEK orcid id orcid.org/0000-0002-1266-3501 ; Department of Endocrinology, Zagreb University Hospital Center, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia

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Abstract

Introduction: Diabetic ketoacidosis (DKA) is one of the most serious acute complications of diabetes mellitus (DM). In some studies, infections have been found to be a precipitating factor in more than half of the subjects. On the other hand, several recent studies emphasize that poor treatment adherence is also a common cause of DKA. Objective: To identify the most common precipitating factors for DKA in Croatia. Patients and Methods: This retrospective, multicenter study included DM type 1 or DM type 2 patients diagnosed with DKA between January 1, 2014 and December 31, 2018, and treated in 5 different DM treatment centers, i.e., Dubrovnik, Našice, Split, Zagreb and Osijek. Only the fi rst episode of DKA was included in the analysis. Patients receiving steroids and DM due to endocrine disorders such as acromegaly and Cushing's syndrome were excluded. Results: The study included 160 patients (55% of men), of whom 68% had DM type 1. The mean age of the respondents was 42 (18-89) years. The most common cause of DKA was infection (57%), followed by poorly controlled DM (37%) and fi rst presentation of DM (9%), while in 7% of patients DKA was due to other causes such as insulin pump failure, stroke or myocardial infarction. In the group of patients with infections, urinary tract infections (30%), gastrointestinal infections (30%) and respiratory tract infections (19%) were most common, whereas 21% of patients had other sources of infection. In 36% of these patients, the infection was associated with previously poorly controlled diabetes, and in 12% of them, DKA caused by the infection was the fi rst manifestation of the disease. In patients with type 2DM, infections were more often the cause of DKA than in patients with type 1DM (p<0.05).Poorly controlled glycemia appeared to be a more frequent cause of DKA in patients with type 1 DM (31%) than in patients with type 2 DM (18%). Conclusion: The most common precipitating factors for the development of DKA were infections and poor diabetes management. Better education of patients about the importance of regular insulin administration and correction of therapy in acute illness could reduce the risk of DKA.

Keywords

diabetes, mellitus; ketoacidosis; precipitating factors; hyperglycemia; insulin; infection

Hrčak ID:

307175

URI

https://hrcak.srce.hr/307175

Publication date:

10.8.2023.

Article data in other languages: croatian

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