title: Clinical profile of diabetic ketoacidosis in tertiary hospitals in China: a multicentre, clinic-based study.
abstract: OBJECTIVE
  To evaluate the clinical profile of patients with diabetic ketoacidosis in tertiary hospitals in China.
  
  
  METHODS
  A retrospective study of patients hospitalized with diabetic ketoacidosis between 2010 and 2012 was carried out in 15 tertiary hospitals around China. Clinical and laboratory data were collected. Patients were classified based on clinical diagnosis and treatment history. Groups were compared for differences in vital statistics and biochemical profiles at presentation.
  
  
  RESULTS
  The study comprised 643 patients with diabetic ketoacidosis: 308 patients (47.9%) with Type 1 diabetes, 294 patients (45.7%) with Type 2 diabetes and 41 patients (6.4%) with atypical diabetes. Three hundred and eighty-eight diabetic ketoacidosis episodes (60.3%) were in patients with known diabetes. The most common precipitating factor was infection (40.1%), followed by unknown causes (36.9%) and non-compliance with anti-diabetes treatment (16.8%). At presentation, gastrointestinal symptoms and dehydration were more common in the Type 1 diabetes group. For new-onset diabetes, only 74.4% and 55.9% of patients were evaluated for β-cell function and autoantibodies for classification. Only 67% of patients with diabetic ketoacidosis received appropriate fluid therapy and 56% patients with severe acidosis received bicarbonate therapy. The length of hospital stay was 10.0 (7.0-14.0) days. The mortality rate was 1.7%, and was much higher in Type 2 diabetes than that in Type 1 diabetes (3.2% vs. 0.4%, P < 0.01).
  
  
  CONCLUSIONS
  Type 2 and Type 1 diabetes contribute to a similar proportion of cases presenting with diabetic ketoacidosis in China. Admissions with diabetic ketoacidosis are still associated with significant mortality and prolonged hospitalization. The efficiency of diabetic ketoacidosis management needs to be improved by implementing the updated guidelines.
authors.affiliation: Department of Endocrinology, First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Epidemiology & Biostatistics, Nanjing Medical University, Nanjing, China.
authors.forename: J
authors.initials: J
authors.lastname: Bai
authors.affiliation: Department of Endocrinology, Affiliated Sir RunRunShaw Hospital, Zhejiang University Hangzhou, Changsha, China.
authors.forename: G
authors.initials: G
authors.lastname: Wang
authors.affiliation: Department of Endocrinology, First People's Hospital of Kunshan, Changsha, China.
authors.forename: S
authors.initials: S
authors.lastname: Zhong
authors.affiliation: Department of Endocrinology, Second Xiangya Hospital of Central South University, Changsha, China.
authors.forename: X
authors.initials: X
authors.lastname: Su
authors.affiliation: Department of Endocrinology and Diabetes Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Huang
authors.affiliation: Department of Endocrinology, Affiliated Hospital of Luzhou Medical College, Shenyang, China.
authors.forename: G
authors.initials: G
authors.lastname: Chen
authors.affiliation: Department of Endocrinology, First Hospital of China Medical University, Shenyang, China.
authors.forename: J
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Endocrinology, Qilu Hospital of ShanDong University, Jinan, China.
authors.forename: X
authors.initials: X
authors.lastname: Hou
authors.affiliation: Department of Endocrinology, Affiliated Hospital of Medical College, Qingdao University, Shenyang, China.
authors.forename: X
authors.initials: X
authors.lastname: Yu
authors.affiliation: Department of Endocrinology and Metabolism, Shanghai Huashan Hospital Affiliated to Fudan University, Shanghai, China.
authors.forename: B
authors.initials: B
authors.lastname: Lu
authors.affiliation: Department of Endocrinology, the First Hospital of Shanxi Medical University, Taiyuan, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Endocrinology, Dongfang Hospital Affiliated to Tongji University, Shanghai, China.
authors.forename: X
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Endocrinology, First Affiliated Hospital of Anhui University, Hefei, China.
authors.forename: H
authors.initials: H
authors.lastname: Hu
authors.affiliation: Department of Endocrinology, Second Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China.
authors.forename: C
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Endocrinology, First Affiliated Hospital of Guangxi Medical University, Nanning, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Liang
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Shaw
authors.affiliation: Department of Endocrinology, First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
authors.forename: X
authors.initials: X
authors.lastname: Wu
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D016883:Diabetic Ketoacidosis / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D007239:Infections / Q000150:complications; D007902:Length of Stay; D008297:Male; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D062606:Tertiary Care Centers