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J Clin Endocrinol Metab. 2019 Sep 14. pii: dgz003. doi: 10.1210/clinem/dgz003. [Epub ahead of print]

The long-term incidence of hospitalization for ketoacidosis in adults with established T1D - a prospective cohort study.

Thomas M1, Harjutsalo V2,3,4,5, Feodoroff M2,3,4, Forsblom C2,3,4,5, Gordin D2,3,4, Groop PH1,2,3,4.

Author information

1
Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia.
2
Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.
3
Department of Nephrology, Department of Medicine Helsinki University Central Hospital, Biomedicum Helsinki, Finland.
4
Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.
5
National Institute for Health and Welfare, The Chronic Disease Prevention Unit, Helsinki, Finland.

Abstract

CONTEXT:

The long-term natural history of diabetic ketoacidosis (DKA) and its risk factors are poorly understood.

OBJECTIVE:

To determine the long-term incidence and predictors of DKA in adults with longstanding type 1 diabetes (T1D).

DESIGN:

All hospitalizations and deaths due to DKA between 1996 and 2016 were identified in 4758 adults with T1D from the Finnish Diabetic Nephropathy Study (FinnDiane), and a cohort of 16224 adults with T1D from the Finnish general population.

RESULTS:

Between 1996 and 2015, there were 1228 DKA events in the FinnDiane participants (1.4/100 person-years) and 4914 DKA events (1.8/100 person-years) in the adults with T1D from the general population. The majority were hospitalized only once. There was a modest increase in the frequency of DKA in the FinnDiane over the follow-up (~2.4%/year [95% CI 0.3-4.5%]; p=0.03). Predictors of DKA were glucose control, CSII, smoking and alcohol consumption, raised HDL cholesterol and triacylglycerides. Diabetic nephropathy and renal impairment were associated with DKA; patients with end-stage renal disease, macroalbuminuria and microalbuminuria had 2.09- (95% CI 1.40-3.12), 1.65- (1.23-2.19) and 0.87- (0.61-1.24) fold risk of DKA, compared to patients with normal albumin excretion rate, respectively. Patients with an eGFR<60 ml/min/1.73m2 were also more likely to be hospitalized for DKA (HR 1.71, [1.26-2.67]).

CONCLUSIONS:

DKA remains a common cause of hospitalization in individuals with longstanding T1D. These data suggest that the goal to use SGLT2 inhibitors for their vasculo- and renoprotective actions may be problematic, as those most likely to benefit may also have the highest risk for DKA.

PMID:
31529090
DOI:
10.1210/clinem/dgz003

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