DIABETIC KETOACIDOSIS;

EVALUATING OUTCOMES IN THE MANAGEMENT OF DIABETIC KETOACIDOSIS AMONG ESTABLISHED AND NEWLY DIAGNOSED TYPE 1 DIABETICS

Abstract

Objectives: To observe the frequency, precipitating factors and outcome of
diabetic ketoacidosis (DKA) in adults with established and newly diagnosed type 1 diabetes
at a tertiary care hospital. Study Design: Retrospective study. Setting: Lahore General
Hospital, Lahore. Period: From January 2013 through December 2015. Methods: Patients who
were admitted with a diagnosis of DKA. The clinical presentations, laboratory investigations,
management, time of recovery and outcome were compared. Data were collected via
retrospective chart review. Results: A total of 202 patients were included who fulfilled the criteria
of DKA, of which 160 (79.2%) were less than 26 years of age with a male predominance of 156
(97.5%). Out of all cases 72 (35.6%) had established Type 1 diabetes and 130 (64.4%) were
newly diagnosed. The most common presenting complaints in both groups were sepsis 105
(52%). The comparison of clinical improvement and laboratory investigations between the two
groups showed that newly diagnosed Type 1 diabetes patients had lower pH, low bicarbonate
and high BSR at presentation as compared to those with established type 1 diabetes. The
patients with established diabetes improved earlier, required lesser duration of intravenous
fluids and IV insulin was changed to subcutaneous in less time. Hospital stay of more than 7
days was observed in patients with new diagnosis. Conclusion: It can be concluded from the
above data that earlier diagnosis of type 1 diabetes mellitus, appropriate treatment, regular
screening for complications and infections will result in less hospital admissions and better
outcome.