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Diabetic Ketoacidosis (DKA)

An emergency condition in which extremely high blood glucose levels, along with a severe lack of insulin, result in the breakdown of body fat for energy and an accumulation of ketones in the blood and urine. Signs of DKA are nausea and vomiting, stomach pain, fruity breath odor, and rapid breathing. Untreated DKA can lead to coma and death.

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(Source: NIH - National Institute of Diabetes and Digestive and Kidney Diseases)

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Evidence reviews

Type 1 Diabetes: Diagnosis and Management of Type 1 Diabetes in Children and Young People

Clinical guidelines have been defined as ‘systematically developed statements which assist clinicians and patients in making decisions about appropriate treatment for specific conditions’. This guideline addresses the diagnosis and management of children and young people with type 1 diabetes. It has been developed with the aim of providing guidance on: initial management at diagnosis (including consideration of admission criteria and initial insulin regimens); continuing care of children and young people with type 1 diabetes; ongoing monitoring of glycaemic control (including the role of home glucose monitoring and the frequency of HbA1c measurement); management of hypoglycaemia (insufficient blood sugar) and hypoglycaemic coma; prevention and management of diabetic ketoacidosis (including the management of intercurrent illness, that is, illness that occurs alongside type 1 diabetes, for example, influenza); peri-operative management of children and young people with type 1 diabetes; and surveillance for complications. The guideline also addresses the special needs of young people (adolescents) and the interface between paediatric and adult services.

Continuous subcutaneous insulin infusion vs intensive conventional insulin therapy in pregnant diabetic women: a systematic review and metaanalysis of randomized, controlled trials

The objective of the study was to study the effects of continuous subcutaneous insulin infusion (CSII) vs multiple-dose insulin (MDI) therapy on glycemic control and pregnancy outcome in diabetic women. Randomized, controlled trials comparing CSII vs MDI in pregnant diabetic women were included after an electronic database search. Studies were rated for quality independently by 2 reviewers in accordance with the Quality of Reporting of Metaanalyses statement. Summary weighted mean difference and odds ratio were estimated for insulin dose, birthweight, gestational age, mode of delivery, hypoglycemic/ketotic episodes, worsening retinopathy, neonatal hypoglycemia, and rates of intrauterine fetal death. Six randomized clinical trials met the inclusion criteria. Pregnancy outcomes and glycemic control were not significantly different among treatment groups. Higher number of ketoacidotic episodes and diabetic retinopathy found in the CSII group did not reach statistical significance. This systematic review does not show any advantage or disadvantage of using CSII over MDI in pregnant diabetic women. Large multicenter, randomized, controlled trials addressing the quality of life/cost effectiveness are required.

Metabolic and target organ outcomes after total pancreatectomy: Mayo Clinic experience and meta-analysis of the literature

INTRODUCTION: Total pancreatectomy (TP) has been associated with substantial metabolic abnormalities and poor glycaemic control limiting its use. Because data reported to date are limited, we evaluated outcomes related to the diabetes mellitus obligated by TP.

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Summaries for consumers

Intensive glucose control versus conventional glucose control for type 1 diabetes mellitus

The primary objective of this review was to assess the positive and negative outcomes of tighter blood glucose control ('intensive' glucose control) compared to less intense treatment targets ('conventional' glucose control) in individuals with type 1 diabetes.

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