DKA risk in secondary diabetes ‘could be underestimated’
medwireNews: Secondary diabetes may carry a higher risk for diabetic ketoacidosis (DKA) than type 1 diabetes does, show findings from a population-based study.
Only 1.0% of the 1732 participants of the Fremantle Diabetes Study Phase II had secondary diabetes, which was mostly a result of chronic pancreatitis.
But the DKA incidence rate in this group was 306.9 per 10,000 person–years. By comparison, the 8.0% of participants with type 1 diabetes had a DKA rate of 166.4 per 10,000 person–years.
The lowest DKA rate occurred among the 85.6% of participants with type 2 diabetes, at 8.3 per 10,000 person–years, while the 4.9% of participants with latent autoimmune diabetes of adults (LADA) had an intermediate rate of 61.4 per 10,000 person–years.
Just one DKA incident was fatal, and this occurred in a patient with secondary diabetes. None of the 0.5% of participants with monogenic diabetes experienced DKA.
“Participants with secondary diabetes, who were few in number but contributed disproportionately to the overall incidence, may be a group in which the risk of DKA could be underestimated,” say study authors Timothy Davis and Wendy Davis, both from the University of Western Australia in Perth.
They add: “There are no previously published comparative data, but the potential for DKA to complicate this form of diabetes has been recognized for some time, including the risk of death as in the case of one of our participants.”
The data are based on a total of 18 confirmed or probable incident DKA cases recorded over an average follow-up of 4.1 years. In addition to these, eight people had 12 recurrent DKA episodes.
When these recurrent cases were combined with the incident cases, the rate per 10,000 person–years was again highest in people with secondary diabetes, at 446.5, followed by 178.6, 121.5, and 13.3 among those with type 1 diabetes, LADA, and type 2 diabetes, respectively.
Having secondary diabetes was independently and significantly associated with first DKA events, as was higher glycated hemoglobin and a lower level of plasma C-peptide (ie, lower residual beta-cell function).
These same three factors were also significantly associated with the frequency of first and recurrent DKA events combined, as was insulin use at study entry.
“Since all participants were insulin-treated at the time of DKA hospitalization, this implies that longer duration insulin treatment may have a role in DKA risk in type 2 diabetes,” write the researchers in BMJ Open Diabetes Research & Care.
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