BACKGROUND Guidelines for the management of diabetic ketoacidosis (DKA) do not consider the type of underlying diabetes. We aimed to compare the occurrence of metabolic adverse events and the recovery time for DKA according to diabetes type. METHODS Multicentre retrospective study conducted at five adult intermediate and intensive care units in Paris and its suburbs, France. All patients admitted for DKA between 2013 and 2014 were included. Patients were grouped and compared according to the underlying type of diabetes into three groups: type 1 diabetes, type 2 or secondary diabetes, and DKA as the first presentation of diabetes. Outcomes of interest were the rate of metabolic complications (hypoglycaemia or hypokalaemia) and the recovery time. RESULTS Of 122 patients, 60 (49.2%) had type 1 diabetes, 28 (22.9%) had type 2 or secondary diabetes and 34 (27.9%) presented with DKA as the first presentation of diabetes (newly diagnosed diabetes). Despite having received lower insulin doses, hypoglycaemia was more frequent in patients with type 1 diabetes (76.9%) than in patients with type 2 or secondary diabetes (50.0%) and in patients with newly diagnosed diabetes (54.6%) (p = 0.026). In contrast, hypokalaemia was more frequent in the latter group (82.4%) than in patients with type 1 diabetes (57.6%) and type 2 or secondary diabetes (51.9%) (p = 0.022). The median recovery times were not significantly different between groups. CONCLUSIONS Rates of metabolic complications associated with DKA treatment differ significantly according to underlying type of diabetes. Decreasing insulin dose may limit those complications. DKA treatment recommendations should take into account the type of diabetes.

中文翻译：

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根据糖尿病类型的糖尿病酮症酸中毒的初步治疗和预后：一项法国多中心观察性回顾性研究。

背景技术糖尿病酮症酸中毒（DKA）的治疗指南没有考虑潜在的糖尿病类型。我们旨在根据糖尿病类型比较代谢不良事件的发生率和DKA的恢复时间。方法在法国巴黎及其郊区的五个成人中级和重症监护室进行了多中心回顾性研究。纳入了2013年至2014年期间接受DKA治疗的所有患者。将患者分组并根据潜在的糖尿病类型分为三类：1型糖尿病，2型或继发性糖尿病，以及首次出现糖尿病的DKA。感兴趣的结果是代谢并发症（低血糖或低血钾）的发生率和恢复时间。结果在122位患者中，有60位（49.2％）患有1型糖尿病，其中28位（22。9％的人患有2型或继发性糖尿病，其中34例（27.9％）的DKA是首次出现的糖尿病（新诊断为糖尿病）。尽管接受了较低剂量的胰岛素治疗，但1型糖尿病患者的低血糖发生率（76.9％）高于2型或继发性糖尿病患者（50.0％）和新诊断为糖尿病的患者（54.6％）（p = 0.026） 。相比之下，后一组的低钾血症发生率更高（82.4％），比1型糖尿病（57.6％）和2型或继发性糖尿病（51.9％）患者的发生率更高（p = 0.022）。两组之间的中位恢复时间无显着差异。结论根据糖尿病的基础类型，与DKA治疗相关的代谢并发症发生率显着不同。减少胰岛素剂量可能会限制这些并发症。