Clinical profile of patients with diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome in Japan: a multicenter retrospective cohort study

Kyosuke Takahashi, Norimichi Uenishi, Masamitsu Sanui, Shigehiko Uchino, Naoki Yonezawa, Tetsuhiro Takei, Norihiro Nishioka, Hirotada Kobayashi, Shunichi Otaka, Kotaro Yamamoto, Hideto Yasuda, Shintaro Kosaka, Hidehiko Tokunaga, Naoki Fujiwara, Takashiro Kondo, Tomoki Ishida, Takayuki Komatsu, Koji Endo, Taiki Moriyama, Takayoshi OyasuMineji Hayakawa, Atsumi Hoshino, Tasuku Matsuyama, Yuki Miyamoto, Akihiro Yanagisawa, Tadamasa Wakabayashi, Takeshi Ueda, Tetsuya Komuro, Toshiro Sugimoto, Alan Kawarai Lefor

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Abstract

Introduction: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS) are life-threatening complications of diabetes mellitus. Their clinical profiles have not been fully investigated. Methods: A multicenter retrospective cohort study was conducted in 21 acute care hospitals in Japan. Patients included were adults aged 18 or older who had been hospitalized from January 1, 2012, to December 31, 2016 due to DKA or HHS. The data were extracted from patient medical records. A four-group comparison (mild DKA, moderate DKA, severe DKA, and HHS) was performed to evaluate outcomes. Results: A total of 771 patients including 545 patients with DKA and 226 patients with HHS were identified during the study period. The major precipitating factors of disease episodes were poor medication compliance, infectious diseases, and excessive drinking of sugar-sweetened beverages. The median hospital stay was 16 days [IQR 10–26 days]. The intensive care unit (ICU) admission rate was 44.4% (mean) and the rate at each hospital ranged from 0 to 100%. The in-hospital mortality rate was 2.8% in patients with DKA and 7.1% in the HHS group. No significant difference in mortality was seen among the three DKA groups. Conclusions: The mortality rate of patients with DKA in Japan is similar to other studies, while that of HHS was lower. The ICU admission rate varied among institutions. There was no significant association between the severity of DKA and mortality in the study population. Trial Registration: This study is registered in the UMIN clinical Trial Registration System (UMIN000025393, Registered 23th December 2016).

Original languageEnglish
Pages (from-to)117-126
Number of pages10
JournalActa Diabetologica
Volume61
Issue number1
DOIs
Publication statusPublished - 01-2024

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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