title: Secondary diabetic ketoacidosis and severe hypoglycaemia in patients with established type 1 diabetes mellitus in China: a multicentre registration study.
abstract: BACKGROUND
  Diabetic ketoacidosis (DKA) and severe hypoglycaemia are common acute complications of type 1 diabetes mellitus (T1DM). This study aimed to determine the incidence of, and risk factors for, these complications in Chinese patients with established T1DM.
  
  
  METHODS
  This cross-sectional study recruited patients with established T1DM from 16 centres in Guangdong Province, China. Incidence rates were expressed as episodes/100 patient-years. Regression models identified risk factors for the occurrence and recurrence of secondary DKA and severe hypoglycaemia.
  
  
  RESULTS
  A total of 611 patients with established T1DM (53.7% women) were recruited. The incidence of secondary DKA and severe hypoglycaemia was 26.4 (22.4, 31.0) and 68.8 (62.2, 76.0)/100 patient-years, respectively. Significant risk factors for secondary DKA were female gender [relative risk (RR) = 2.12], medical reimbursement rate <50% (RR = 1.84), uncontrolled diet (RR = 1.76), smoking (RR = 2.18) and poor glycaemic control [glycated haemoglobin A1c (HbA1c)/1.0% increase; RR = 1.15]. Overweight/obesity was a protective factor (RR = 0.57). Significant risk factors for severe hypoglycaemia included male gender (RR = 1.71), medical reimbursement rate < 50% (RR = 1.36), longer duration of T1DM (per 5-year increase, RR = 1.22), underweight (RR = 1.44), uncontrolled diet ('never controlled' or 'sometimes controlled' vs. 'usually controlled', RR = 2.09 or 2.02, respectively), exercise <150 min/week (RR = 1.66), presence of neuropathy (RR = 1.89), smoking (RR = 1.48) and lower HbA1c values (per 1.0% decrease, RR = 1.46). Overweight/obesity was a protective factor (RR = 0.62). Additionally, 34.4% of secondary DKA and 81.1% of severe hypoglycaemia episodes occurred in 3.8% and 16.2% patients with recurrent events (≥two episodes), respectively.
  
  
  CONCLUSIONS
  The results indicate that secondary DKA and severe hypoglycaemia occur at high rates in Chinese patients with established T1DM and that recurrence is likely to occur in high-risk patients. Comprehensive management of T1DM should include recommendations to control modifiable risk factors.
authors.affiliation: Department of Endocrinology and Metabolic Disease of the Third Affiliated Hospital, and Guangdong Provincial Key Laboratory of Diabetology, Sun Yat-Sen University, Guangzhou, China; Guangdong Diabetes Center, Sun Yat-sen University, Guangzhou, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Li
authors.forename: Daizhi
authors.initials: D
authors.lastname: Yang
authors.forename: Jinhua
authors.initials: J
authors.lastname: Yan
authors.forename: Bin
authors.initials: B
authors.lastname: Huang
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.forename: Jianping
authors.initials: J
authors.lastname: Weng
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003131:Combined Modality Therapy / Q000191:economics; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000191:economics / Q000503:physiopathology* / Q000628:therapy; D016883:Diabetic Ketoacidosis / Q000191:economics / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000191:economics / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D015994:Incidence; D007349:Insurance, Health, Reimbursement; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012307:Risk Factors; D012720:Severity of Illness Index; D012727:Sex Characteristics; D012907:Smoking / Q000009:adverse effects; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Chinese; diabetes mellitus; diabetic ketoacidosis; incidence; risk factors; severe hypoglycaemia; type 1