Diabetic ketoacidosis: recurrent episodes increased the risk of death and diabetic or pregnancy complications.

Clinical bottom line (level 4)

  1. A fifth of women with recurrent diabetic ketoacidosis were dead within 10 years.
  2. Two thirds had a diabetic complication and about three quarters had a pregnancy complication in this time.
  3. Only a tenth still had recurrent DKA after 10 years.
Kent et al: Lancet 1994; 344: 778-781
Expires October 2003

The study

Case-control study with unblinded, unobjective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: diabetic centres in two acute hospitals, UK, 1979 to 1985

60 patients (aged ?, 100% female) diabetes mellitus

Excluded if
  • C-peptide positive


    • Cases: 33 patients (100% female, mean age -): referred to either of two diabetologists with life-disrupting recurrent diabetic ketoacidosis
    Controls: 27 patients (100% female, mean age ): stable diabetes mellitus

    Factors studied:
  • death, diabetic complication, pregnancy complication, still brittle at follow-up


    • Factors summarised:
  • recurrent DKA
  • recurrent DKA


    • Outcomes studied:
  • death
  • diabetic complication
  • pregnancy complication

    • 79% of patients were followed for 6.6 to 12 years (mean 11)

    The evidence

    Patient expected event rate for death: 19%
    Patient expected event rate for diabetic complication: 67%
    risk factor diabetic complication
    present    		 diabetic complication
    absent    		 unadjusted OR
    (95% CI)    		 NNH
    (95% CI)
    recurrent DKA 14 7 2.67
    (1.18 to 6.04)     		2
    (1 to 22)
    no recurrent DKA 5 15

    Patient expected event rate for pregnancy complication: 73%
    risk factor pregnancy complication
    present    		 pregnancy complication
    absent    		 unadjusted OR
    (95% CI)    		 NNH
    (95% CI)
    recurrent DKA 13 15 6.27
    (1.56 to 25.2)     		3
    (1 to 24)
    no recurrent DKA 2 25

    • 9.5% of brittle diabetics were still brittle at 10y follow-up
    • No figure for mortality rate in stable diabetes given.
    • No firm definition is found of brittle diabetes.

    Citation

    1. Kent LA, Gill GV, Williams G: Mortality and outcome of patients with brittle diabetes and recurrent ketoacidosis. Lancet 1994; 344: 778-781
    Contributor: Richard Hardern and Chris Ball, July 2000
    Reviewer: Tadao Okada

    Clinical Question.
    Patient diabetes
    Intervention or Exposure recurrent DKA
    Outcome mortality and complications