Current Clinical Features of Diabetic Ketoacidosis in Adults: A German Multicenter Study 2022 – 2023

Objective: To identify clinical features and causes of diabetic ketoacidosis (DKA) in adults leading to hospital admission.

Methods: Observational multicenter study investigating frequency and clinical features of DKA in patients admitted to one of three German tertiary care hospitals and two university hospitals between 2022 and 2023. Amongst others, analysis were stratified for type of diabetes mellitus as well as pre-existing vs. onset T1DM and T2DM.

Results: A total of 183 patients with 206 episodes of DKA were enrolled. 52% cases were related to pre-existing T1DM, 16% to new-onset T1DM, 15% to pre-existing T2DM, 4% to new-onset T2DM, 7% to LADA, 7% to pancreatogenic diabetes. We encountered 7 cases SGLT 2 inhibitor (SGLT 2-I) associated euglycaemic DKA (EDKA) of which there was 1 T1DM, 4 T2DM, 1 LADA and 1 pancreatogenic DM. 35% of cases were classified as mild, 33% as moderate and 32% as severe . Clinical symptoms of nausea and disturbances of consciousness were significantly more accentuated in individuals with pre-existing T1DM and T2DM than in individuals with new-onset diabetes mellitus (p<0,05). In pre-existing T1DM, DKA occurred despite continuous glucose monitoring (CGM) in 38% of patients and continuous subcutaneous insulin infusion (CSII) or automated insulin delivery (AID) in 22%. Only a minority of individuals with T1DM (14%) were in possession of ketone test and only 4% used one. 49% of patients with pre-existing T1DM experienced recurrent episodes of DKA. These patients were significantly younger and showed a higher HbA1c compared to those without recurrent DKAs (p<0.05). Suboptimal adherence to diabetes therapy was the most common triggering factor (50%) for DKA in subjects with known T1DM, while infections were the most common contributing factor in patients with pre-existing T2DM (28%).Type 2 diabetics treated with SGLT2-Is (55%) and particularly those that developed SGLT2-I associated euglycemic ketoacidosis (EDKA) were not educated concerning sick day rules. The inpatient mortality of DKA was 1.5% (3/206) and was limited to individuals with pre-existing T2DM characterized by severe comorbidities. Causes of death included COVID-19 infections and urogenital sepsis.

Conclusions: The clinical presentation of DKA is very heterogeneous depending on type and duration of diabetes. Pre-diagnosed diabetics showed severe educational deficits concerning diagnostic and therapeutic measures to prevent DKA. Individuals with recurrent episodes of DKA remain a group of concern, requiring individual therapeutic concepts within the multidisciplinary diabetes care team. Our data highlight the importance of emphasizing sick day rules in patients being treated with SGLT 2-Is in order to prevent EDKA. Individuals with pre-existing T2DM experiencing DKA are a highly vulnerable group due to severe comorbidities entailed by higher mortality risk due to severe comorbidities entailed by higher mortality risk due to DKA

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Artikel online veröffentlicht:
28. Mai 2025