Clinical and Epidemiological Characteristics of Diabetic Ketoacidosis in Older Adults - American Geriatric Society

OBJECTIVES

Much of the research previously done on diabetic ketoacidosis (DKA) was based on a young population with type 1 diabetes mellitus (type 1 DM). But substantial numbers of DKA episodes occur in patients with a prior history of type 2 diabetes mellitus (type 2 DM). There is a lack of Data are lacking about DKA in older adults. The aims of this study were to analyze the clinical characteristics and outcomes of older adult patients with DKA.

DESIGN

Retrospective matched cohort study of adult patients hospitalized with DKA between 2004 and 2017.

SETTING

Soroka University Medical Center, Be'er Sheva, Israel.

PARTICIPANTS

The clinical characteristics of DKA patients 65 years and older were compared with patients younger than 65 years.

MEASUREMENTS

The primary outcome was in‐hospital mortality.

RESULTS

The study cohort included 385 consecutive patients for whom the admission diagnosis was DKA: 307 patients (79.7%) younger than 65 years (group 1), and 78 patients (20.3%) older than 65 years (group 2). Patients in group 2 compared with group 1 had a significantly higher Charlson index (6 [6–6] vs 6 [6–7]; P < .0001) and DM with target organ damage (24.4% vs 6.2%; P < .0001). Patients in group 2 compared with group 1 had more serious disease according to results of laboratory investigations. The total in‐hospital mortality rate of patients in group 2 was 16.7% compared with 1.6% in patients in group 1 in a sex and co‐morbidities matched analysis (P = .001).

CONCLUSIONS

DKA in older adults is a common problem. The serious co‐morbidities and precipitating factors such as infection/sepsis, myocardial infarction, and cerebrovascular accidents, may explain the severity of the problem of DKA in older adults and the high rate of mortality of these patients. DKA appears to be a lifethreatening condition in older adults. The alertness of physicians to DKA in older adults, timely diagnosis, proper treatment, and prevention are cornerstones of care.

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