Incidence Of Diabetic Ketoacidosis Among Patients With Type 2 Diabetes Mellitus Treated With Sglt2 Inhibitors And Other Antihyperglycemic Agents
Highlights • Overall, unadjusted DKA incidence were similar between SGLT2 and non-SGLT2 agents. • Overall, unadjusted DKA incidence dropped by ∼50% when excluding potential autoimmune diabetes. • Primary analysis found no statistically significant increased risk of DKA with SGLT2 inhibitors. • No increased risk of DKA with SGLT2 inhibitors when excluding potential autoimmune diabetes. • More than half of the DKA cases met the definition of potential autoimmune diabetes. Abstract To estimate and compare incidence of diabetes ketoacidosis (DKA) among patients with type 2 diabetes who are newly treated with SGLT2 inhibitors (SGLT2i) versus non-SGLT2i antihyperglycemic agents (AHAs) in actual clinical practice. A new-user cohort study design using a large insurance claims database in the US. DKA incidence was compared between new users of SGLT2i and new users of non-SGLT2i AHAs pair-matched on exposure propensity scores (EPS) using Cox regression models. Overall, crude incidence rates (95% CI) per 1000 patient-years for DKA were 1.69 (1.22–2.30) and 1.83 (1.58–2.10) among new users of SGLT2i (n = 34,442) and non-SGLT2i AHAs (n = 126,703). These rates more than doubled among patients with prior insulin prescriptions but decreased by more than half in analyses that excluded potential autoimmune diabetes (PAD). The hazard ratio (95% CI) for DKA comparing new users of SGLT2i to new users of non-SGLT2i AHAs was 1.91 (0.94–4.11) (p = 0.09) among the 30,196 EPS-matched pairs overall, and 1.13 (0.43–3.00) (p = 0.81) among the 27,515 EPS-matched pairs that excluded PAD. This was the first observational study that compared DKA risk between new users of SGLT2i and non-SGLT2i AHAs among patients with type 2 diabetes, and overall no statistically significant differen Continue reading >>
Diabetic Ketoacidosis
Diabetes mellitus is the name given to a group of conditions whose common hallmark is a raised blood glucose concentration (hyperglycemia) due to an absolute or relative deficiency of the pancreatic hormone insulin. In the UK there are 1.4 million registered diabetic patients, approximately 3 % of the population. In addition, an estimated 1 million remain undiagnosed. It is a growing health problem: In 1998, the World Health Organization (WHO) predicted a doubling of the worldwide prevalence of diabetes from 150 million to 300 million by 2025. For a very tiny minority, diabetes is a secondary feature of primary endocrine disease such as acromegaly (growth hormone excess) or Cushing’s syndrome (excess corticosteroid), and for these patients successful treatment of the primary disease cures diabetes. Most diabetic patients, however, are classified as suffering either type 1 or type 2 diabetes. Type 1 diabetes Type 1 diabetes, which accounts for around 15 % of the total diabetic population, is an autoimmune disease of the pancreas in which the insulin-producing β-cells of the pancreas are selectively destroyed, resulting in an absolute insulin deficiency. The condition arises in genetically susceptible individuals exposed to undefined environmental insult(s) (possibly viral infection) early in life. It usually becomes clinically evident and therefore diagnosed during late childhood, with peak incidence between 11 and 13 years of age, although the autoimmune-mediated β-cell destruction begins many years earlier. There is currently no cure and type 1 diabetics have an absolute life-long requirement for daily insulin injections to survive. Type 2 diabetes This is the most common form of diabetes: around 85 % of the diabetic population has type 2 diabetes. The primary prob Continue reading >>
Medical Pharmacology Chapter 29:
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Diabetes Mellitus
Return to The Medical Biochemistry Page Diabetes is any disorder characterized by excessive urine excretion. The most common form of diabetes is diabetes mellitus, a metabolic disorder in which there is an inability to oxidize carbohydrate due to disturbances in insulin function. Diabetes mellitus is characterized by elevated glucose in the plasma and episodic ketoacidosis. Additional symptoms of diabetes mellitus include excessive thirst, glucosuria, polyuria, lipemia and hunger. If left untreated the disease can lead to fatal ketoacidosis. Other forms of diabetes include diabetes insipidus and brittle diabetes. Diabetes insipidus is the result of a deficiency of antidiuretic hormone (ADH, also referred to as vasopressin or arginine vasopressin, AVP). The major symptom of diabetes insipidus (excessive output of dilute urine) results from an inability of the kidneys to resorb water. Brittle diabetes is a form that is very difficult to control. It is characterized by unexplained oscillations between hypoglycemia and acidosis. Criteria, which clinically establish an individual as suffering from diabetes mellitus, include: 1. having a fasting plasma glucose level in excess of 126mg/dL (7mmol/L). Normal levels should be less than 100mg/dL (5.6mmol/L) or: 2. having plasma glucose levels in excess of 200mg/dL (11mmol/L) at two times points during an oral glucose tolerance test, OGTT, one of which must be within 2 hrs of ingestion of glucose. Different clinical labs may use different units for the measurement of serum glucose concentrations, either in mmol/L or mg/dL. One can easily interconvert these values using the following formulas: mg/dL x 0.0555 = mmol/L (or simply divide mg/dL by 18) mmol/L x 18.0182 = mg/dL (or simply multiply mmol/L by 18) The earlier a person is dia Continue reading >>
Peer Reviewers
Pediatric Diabetic Ketoacidosis: An Outpatient Perspective On Evaluation and Management Abstract Diabetic ketoacidosis is a common, serious acute complication in children with diabetes mellitus. Diabetic ketoacidosis can accompany new-onset type 1 diabetes mellitus or it can occur with established type 1 diabetes mellitus during the increased demands of an acute illness or with decreased insulin delivery due to omitted doses or insulin pump failure. Additionally, diabetic ketoacidosis episodes in children with type 2 diabetes mellitus are being reported with greater frequency. Although the diagnosis is usually straightforward in a known diabetes patient with expected findings, a fair proportion of patients with new-onset diabetes present in diabetic ketoacido- sis. The initial management of children with diabetic ketoacidosis frequently occurs in an emergency department. Physicians must be aware that diabetic ketoacidosis is an important consideration in the differential diagnosis of pediatric metabolic acidosis. This review will acquaint emergency medicine clinicians with the pathophysiology, treatment, and potential complications of this disorder. Author William Bonadio, MD Attending Physician, Pediatric Emergency Medicine, Maimonides Medical Center, Brooklyn, NY Arleta Rewers, MD, PhD Associate Professor of Pediatrics, University of Colorado, Denver, School of Medicine, Aurora, CO Joseph I. Wolfsdorf, MD Clinical Director, Division of Endocrinology, Boston Children’s Hospital, Professor of Pediatrics, Harvard Medical School, Boston, MA CME Objectives Upon completion of this article, you should be able to: 1. Describe the pathophysiology of DKA and the associated clinical signs and symptoms of this disorder. 2. Discuss management of DKA to restore metabolic hom Continue reading >>
Keto-
Also found in: Dictionary, Encyclopedia, Wikipedia. keto- (kē'tō), Combining form denoting a compound containing a ketone group; replaced by oxo- in systematic nomenclature. keto- prefix indicating possession of the carbonyl (:C:O) group: ketoheptose, ketolysis, ketonuria. keto- Combining form denoting a compound containing a ketone group; replaced by oxo- in systematic nomenclature. Want to thank TFD for its existence? Tell a friend about us, add a link to this page, or visit the webmaster's page for free fun content. Link to this page: Continue reading >>
Diabetes In Childhood And Adolescence
POCKETBOOK FOR MANAGEMENT OF IN UNDER-RESOURCED COUNTRIES 2 nd Edition 2017 The Pocket Book was prepared and edited by: • Dr. Graham Ogle, MBBS FRACP, General Manager, IDF Life for a Child Programme, Sydney Australia • Mrs. Angela Middlehurst, RN RSCN CDE, Education Manager, IDF Life for a Child Programme, Sydney Australia • Prof. Martin Silink, MBBS, MD, FRACP, Professor of Paediatric Endocrinology, University of Sydney and Chairman, IDF Life for a Child Programme and Sydney Australia • Assoc. Prof. Ragnar Hanas, MD, PhD, Uddevalla Hospital, NU Hospital Group, Uddevalla, Sweden (for ISPAD) For information on the IDF Life for a Child Programme see Chapter 16 and also www.idf.org/lifeforachild This Pocket book has been prepared and printed with financial support from the Leona M. and Harry B. Helmsley Charitable Trust and the Fondation de l’Orangerie. 2nd Edition, International Diabetes Federation, Brussels, 2017 Pocketbook for Management of Diabetes in Childhood and Adolescence in Under-Resourced Countries 2nd Edition 3 These guidelines have been developed taking into account resource- and cost-related issues affecting care for children and youth with diabetes in developing countries. Healthcare funding and available expertise vary from country to country and often also within a particular country, and therefore it is challenging to write a broad document to meet all needs. The information in these guidelines is aimed to assist health care professionals in developing countries to optimise the clinical practice they are able to give in their particular centre. In many cases, subsequent referral to a centre with greater expertise is appropriate. It is estimated that there are approximately 542,000 children under the age of 15 years with type Continue reading >>
Diabetic Emergencies
AUTHORS Jeremy Rohrlich, MD, Emergency Medicine Resident, Department of Emergency Medicine, University of Texas Southwestern, Parkland Hospital, Dallas. Richard Williams, DO, Emergency Medicine Resident, Department of Emergency Medicine, University of Texas Southwestern, Parkland Hospital, Dallas. Fernando Benitez, MD, Professor, Department of Emergency Medicine, University of Texas Southwestern, Dallas. Larissa Velez, MD, Program Director and Vice-Chair for Education, Department of Emergency Medicine, University of Texas Southwestern, Dallas. PEER REVIEWER Catherine A. Marco, MD, FACEP, Professor, Emergency Medicine and Surgery, Wright State University, Dayton, OH. Statement of Financial Disclosure To reveal any potential bias in this publication, and in accordance with Accreditation Council for Continuing Medical Education guidelines, we disclose that Dr. Farel (CME question reviewer) owns stock in Johnson & Johnson. Dr. Schneider (editor), Dr. Stapczynski (editor), Ms. Fessler (nurse planner), Dr. Rohrlich (author), Dr. Williams (author), Dr. Benitez (author), Dr. Velez (author), Dr. Marco (peer reviewer), Ms. Mark (executive editor), and Ms. Coplin (executive editor) report no financial relationships with companies related to the field of study covered by this CME activity. EXECUTIVE SUMMARY Suspect diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar state (HHS) in an ill patient with hyperglycemia. In DKA, the acidosis is prominent. In HHS, volume contraction and hyperosmolality are prominent. DKA treatment sequence is fluids, potassium (if low), and insulin. Identify and treat precipitating causes. Point-of-care glucose testing devices may give false values, especially using capillary blood. In the treatment of an unresponsive hypoglycemic patient, consider Continue reading >>
Corticosteroids And Diabetes
Tweet Use of corticosteroids to treat inflammation can lead to higher than normal blood glucose levels and, in longer term usage may lead to type 2 diabetes developing. What are corticosteroids? Corticosteroids are medications that contain synthetic versions of cortisol, the hormone produced by our adrenal glands and responsible for the body’s stress response. Corticosteroids may be taken orally in tablet form, via inhalers, via injections or within lotions, gels and creams. Examples of steroid medications include: Prednisolone Hydrocortisone Dexamethesone Fludrocortisone Deflazacort Corticosteroids are not to be confused with anabolic steroids, a type of steroid and class C drug which some body builders use, illegally, to build muscle. When are corticosteroids used or prescribed? Corticosteroids may be used to control inflammation as a result of conditions including: Rhuematoid arthritis Asthma Ulcerative colitis Chron’s disease Lupus Addison’s disease Can steroids lead to diabetes? One of the side effects of oral corticosteroids is that they can increase blood glucose levels and increase insulin resistance, which can lead to type 2 diabetes. Typically, blood glucose levels will return to normal after you finish taking the steroids but in some cases, particularly if you have pre-existing risk factors for type 2 diabetes, you may be diagnosed with this form of diabetes. Being on steroids for a longer period of time, over 3 months, may also increase your risk of type 2 diabetes. Treating diabetes when on steroids If you have diabetes prior to starting on oral corticosteroids, you need to be aware that your blood glucose levels may rise whilst you are taking steroids. This is more likely to be the case if you are taking steroids orally. If you do not currently monit Continue reading >>
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What Is The Difference Between Hyperglycemia And Hypoglycemia?
By Debra A. Sokol-McKay, MS, CVRT, CDE, CLVT, OTR/L, SCLV What Is Hyperglycemia? In relation to diabetes, hyperglycemia refers to chronically high blood glucose levels. Most medical professionals define hyperglycemia by using the blood glucose goals that you and your physician have established and combining those goals with the blood glucose target ranges set by the American Diabetes Association. It's important to understand that you'll probably experience high blood glucose levels from time to time, despite your best efforts at control. As with any chronic disease, talk with your physician and diabetes care team if the pattern of your blood glucose readings is consistently higher or lower than your blood glucose goals. Complications from Hyperglycemia Persistent hyperglycemia can cause a wide range of chronic complications that affect almost every system in your body. When large blood vessels are affected, it can lead to: Stroke (cerebral vascular disease) Heart attack or Congestive Heart Failure (coronary heart disease) Circulation disorders and possible amputation (peripheral vascular disease) When smaller blood vessels are affected, it can lead to: Kidney disease (nephropathy) Nerve damage (neuropathy) Diabetic eye disease (retinopathy) Joseph Monks: Writer, Producer, and Film Director Joseph Monks, who has diabetic retinopathy, creates and produces films for his production company Sight Unseen Pictures. He is also the first blind filmmaker to direct a feature film. Says Joe, "I'm not uncomfortable with the term 'blind.' I'm not thrilled about it, of course, but it's accurate. The lights went out for me in early 2002 as a result of diabetic retinopathy—the death of my retinas. It is what it is, so when it happened, I decided that I wasn't going to let it put an en Continue reading >>
Invokana Lawsuit
The U.S. Food and Drug Administration has issued a new safety alert regarding a possible increase in the risk of leg or foot amputation after taking the antidiabetic medication, Invokana. Previous safety warnings were also issued about an increased risk of severe urinary tract infection and diabetic ketoacidosis which has required hospitalization and dialysis due to kidney failure. Invokana, a medication used to treat Type 2 diabetes, may have caused serious injury in some patients. Patients who have taken Invokana may have experienced leg, foot or toe amputation, kidney failure, heart attack or other events which were life-threatening or resulted in permanent injury. Many of these patients or their family members have filed an Invokana lawsuit against the manufacturer of Invokana, stating that the company failed to warn the public and the medical community about the potential risks of the medication. If you or a loved one required amputation, experienced kidney failure with dialysis, heart attack or other serious injuries after taking Invokana, you may be eligible for legal compensation. What is Invokana? Invokana (canagliflozin) is a newer type of anti-diabetic medication used to treat Type 2 diabetes. It is a member of the class “SGLT2 inhibitors” (sodium-glucose-co-transporter 2) medications that work to lower blood sugar by encouraging the body to release excess sugar into the urine. Normally, insulin is secreted by the body to help move sugar or glucose from the bloodstream into the cells where it can be used as energy. Type 2 diabetics are often resistant to insulin, causing the sugar to remain in the blood stream, unusable by the cells. This excess sugar is excreted into the urine but is reabsorbed by the kidneys. Over time, high blood sugar may cause perman Continue reading >>
Diabetic Ketoacidosis And Hyperglycemic Hyperosmolar Syndrome After Renal Transplantation In The United States
Abstract The incidence and risk factors for diabetic ketoacidosis (diabetic ketoacidosis) and hyperglycemic hyperosmolar syndrome (hyperglycemic hyperosmolar syndrome, previously called non-ketotic hyperosmolar coma) have not been reported in a national population of renal transplant (renal transplantation) recipients. We performed a historical cohort study of 39,628 renal transplantation recipients in the United States Renal Data System between 1 July 1994 and 30 June 1998, followed until 31 Dec 1999. Outcomes were hospitalizations for a primary diagnosis of diabetic ketoacidosis (ICD-9 code 250.1x) and hyperglycemic hyperosmolar syndrome (code 250.2x). Cox Regression analysis was used to calculate adjusted hazard ratios for time to hospitalization for diabetic ketoacidosis or hyperglycemic hyperosmolar syndrome. The incidence of diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome were 33.2/1000 person years (PY) and 2.7/1000 PY respectively for recipients with a prior diagnosis of diabetes mellitus (DM), and 2.0/1000 PY and 1.1/1000 PY in patients without DM. In Cox Regression analysis, African Americans (AHR, 2.71, 95 %CI, 1.96–3.75), females, recipients of cadaver kidneys, patients age 33–44 (vs. >55), more recent year of transplant, and patients with maintenance TAC (tacrolimus, vs. cyclosporine) had significantly higher risk of diabetic ketoacidosis. However, the rate of diabetic ketoacidosis decreased more over time in TAC users than overall. Risk factors for hyperglycemic hyperosmolar syndrome were similar except for the significance of positive recipient hepatitis C serology and non-significance of female gender. Both diabetic ketoacidosis (AHR, 2.44, 95% CI, 2.10–2.85, p < 0.0001) and hyperglycemic hyperosmolar syndrome (AHR 1.87, 95% CI, 1.22� Continue reading >>
- Incidence of End-Stage Renal Disease Attributed to Diabetes Among Persons with Diagnosed Diabetes United States and Puerto Rico, 20002014
- Diabetic Ketoacidosis Increases Risk of Acute Renal Failure in Pediatric Patients with Type 1 Diabetes
- Disparities in Diabetes Deaths Among Children and Adolescents United States, 20002014
Talk:diabetic Ketoacidosis
Diabetic ketoacidosis has been listed as one of the Natural sciences good articles under the good article criteria. If you can improve it further, please do so. If it no longer meets these criteria, you can reassess it. August 4, 2009 Good article nominee Listed Ideal sources for Wikipedia's health content are defined in the guideline Wikipedia:Identifying reliable sources (medicine) and are typically review articles. Here are links to possibly useful sources of information about Diabetic ketoacidosis. PubMed provides review articles from the past five years (limit to free review articles or to systematic reviews) The TRIP database provides clinical publications about evidence-based medicine. Other potential sources include: Centre for Reviews and Dissemination and CDC WikiProject Medicine [hide](Rated GA-class, Mid-importance) This article is within the scope of WikiProject Medicine, which recommends that medicine-related articles follow the Manual of Style for medicine-related articles and that biomedical information in any article use high-quality medical sources. Please visit the project page for details or ask questions at Wikipedia talk:WikiProject Medicine. GA This article has been rated as GA-Class on the project's quality scale. Mid This article has been rated as Mid-importance on the project's importance scale. Comment[edit] The section "Ketone body production" is very poor; it needs rewritten. Ketones needn't be desribed as "fuel for the brain" - they are used in the production of acetyl-CoA. —Preceding unsigned comment added by Dermotmallon (talk • contribs) 10:54, 10 June 2008 (UTC) more re ketone bodies[edit] The mechanism section does not clearly explain the pathophysiology of DKA. I am not an expert, but I believe the release of acidifying ketone bod Continue reading >>
Diabetes Mellitus (dm) In Children And Adolescents
Diabetes mellitus is a disorder in which blood sugar (glucose) levels are abnormally high because the body does not produce enough insulin or fails to respond normally to the insulin produced. Treatment depends on the type of diabetes but includes changes in diet, exercise, weight loss (if overweight), and insulin injections or drugs taken by mouth. The symptoms, diagnosis, and treatment of diabetes are similar in children and adults (see Diabetes Mellitus (DM)). However, management of diabetes in children may be more complex. It must be tailored to the child’s physical and emotional maturity level and to constant variations in food intake, physical activity, and stress. Blood sugar Diabetes is a disorder that affects the amount of sugar in the blood. There are many kinds of sugar. The white granules of table sugar are known as sucrose. Sucrose occurs naturally in sugar cane and sugar beets. Another kind of sugar, lactose, occurs in milk. Sucrose consists of two different simple sugars, glucose and fructose. Lactose consists of the simple sugars glucose and galactose. Sucrose and lactose must be broken down by the intestine into their simple sugars before they can be absorbed. Glucose is the main sugar the body uses for energy, so during and after absorption, most sugars are turned into glucose. Thus, when doctors talk about blood sugar, they are really talking about blood glucose. Types of Diabetes The types of diabetes in children are similar to those in adults. The types include Prediabetes is a condition in which blood glucose levels are too high to be considered normal but not high enough to be considered diabetes. Prediabetes is more common among obese adolescents. It is temporary in over half of adolescents, but the remainder develop diabetes, especially those Continue reading >>
Diabetic Emergencies, Diabetic Ketoacidosis In Adults, Part 3
Clinical Management Treatment consists of rehydration with intravenous fluids, the administration of insulin, and replacement of electrolytes. General medical care and close supervision by trained medical and nursing staff is of paramount importance in the management of patients with DKA. A treatment flowchart (Table 1.3) should be used and updated meticulously. A urine catheter is necessary if the patient is in coma or if no urine is passed in the first 4 hours…. Replacement of water deficit Patients with DKA have severe dehydration. The amount of fluid needing to be administered depends on the degree of dehydration (Table 1.4). Fluid replacement aims at correction of the volume deficit and not to restore serum osmolality to normal. Isotonic solution NaCl (0.9%) (normal saline; osmolality 308 mOsm/kg) should be administered even in patients with high serum osmolality since this solution is hypotonic compared to the extracellular fluid of the patient. 10 The initial rate of fluid administration depends on the degree of volume depletion and underlying cardiac and renal function. In a young adult with normal cardiac and/or renal function 1 L of normal saline is administered intravenously within the first half- to one hour. In the second hour administer another 1 L, and between the third and the fifth hours administer 0.5–1 L per hour. Thus, the total volume in the first 5 hours should be 3.5–5 L [1]. If the patient is in shock or blood pressure does not respond to normal saline infusion, colloid solutions together with normal saline may be used.1,6 Some authors suggest replacement of normal saline with hypotonic (0.45%) saline solution after stabilization of the hemodynamic status of the patient and when corrected serum sodium levels are normal.8 However, this appro Continue reading >>
