title: Distinct clinical characteristics and therapeutic modalities for diabetic ketoacidosis in type 1 and type 2 diabetes mellitus.
abstract: OBJECTIVE
  Patients with type 1 diabetes often develop diabetic ketoacidosis (DKA). Reportedly, DKA in type 2 diabetes has higher mortality despite its limited occurrence. The exact clinical characteristics and therapeutic modalities yielding successful outcomes in DKA type 2 diabetes remain unknown.
  
  
  METHODS
  This retrospective study compared the clinical features and detailed treatment of consecutive type 1 and type 2 diabetes patients hospitalized with DKA between January 2001 and December 2014.
  
  
  RESULTS
  We report on 127 patients with type 1 and 74 patients with type 2 diabetes whose DKA was successfully treated. The most frequent precipitating cause for DKA was infectious disease for patients with type 1 diabetes and consumption of sugar-containing beverages for those with type 2 diabetes. Type 2 diabetes patients showed higher mean plasma glucose levels than those with type 1 diabetes (48.4±21.6, vs. 37.1±16.4mmol/l, P<0.01) and higher serum creatinine, blood urea nitrogen, and hemoglobin levels, which normalized after DKA resolution. Compared with type 1 diabetes patients, those with type 2 diabetes required distinctly higher daily total insulin dosage (35.9±37.0U, vs. 20.2±23.3U, P<0.01), larger replacement fluid volumes (4.17±2.69L, vs. 2.29±1.57L, P<0.01) and greater potassium supplementation (23.9±36.5mEq, vs. 11.2±17.9mEq, P<0.01) to resolve DKA and reduce plasma glucose level to ≤16.7mmol/l.
  
  
  CONCLUSIONS
  DKA patients with type 2 diabetes required management with a modified treatment protocol to resolve their profound hyperglycemia and dehydration compared with those with type 1 diabetes.
authors: Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Sagamihara, Kanagawa, 252-0374, Japan. Electronic address: ykamata@med.kitasato-u.ac.jp.
authors: Yuji
authors: Y
authors: Kamata
authors: Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Sagamihara, Kanagawa, 252-0374, Japan.
authors: Koji
authors: K
authors: Takano
authors: Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Sagamihara, Kanagawa, 252-0374, Japan.
authors: Eriko
authors: E
authors: Kishihara
authors: Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Sagamihara, Kanagawa, 252-0374, Japan.
authors: Michiko
authors: M
authors: Watanabe
authors: Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Sagamihara, Kanagawa, 252-0374, Japan.
authors: Raishi
authors: R
authors: Ichikawa
authors: Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, Sagamihara, Kanagawa, 252-0374, Japan.
authors: Masayoshi
authors: M
authors: Shichiri
mesh_terms: D000328:Adult; D000368:Aged; D001628:Beverages / Q000009:adverse effects; D001786:Blood Glucose / Q000032:analysis; D003131:Combined Modality Therapy / Q000009:adverse effects; D003141:Communicable Diseases / Q000150:complications / Q000503:physiopathology; D003681:Dehydration / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000208:ethnology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000208:ethnology / Q000628:therapy*; D016883:Diabetic Ketoacidosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy; D000073417:Dietary Sugars / Q000009:adverse effects; D018450:Disease Progression; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D062606:Tertiary Care Centers
chemical_list: D001786:Blood Glucose; D000073417:Dietary Sugars
keywords: Diabetic ketoacidosis; Insulin therapy; Precipitating cause; Type 1 diabetes; Type 2 diabetes