Diabetes mellitus: brittle: recurrent ketoacidosis and hypoglycaemia were common.

Clinical bottom line (level 4)

  1. Recurrent episodes of hypoglycaemia or diabetic ketoacidosis were common in patients with 'brittle' diabetes up to 12 years after initial diagnosis.
Tattersall et al: British Medical Journal 1991; 302: 1240-1243
Expires October 2003

The study

Case series with ?objective ?blinded outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: two acute hospitals, UK, 1977-1979

25 patients (aged range 2 to 41 years, 52% male) brittle diabetes (defined as 3 or more episodes of ketoacidosis (44%) or hypoglycaemia)


88% followed for 12 years
Outcomes studied:
  • hypoglycaemia in past two years
  • ketoacidosis in past two years
  • death

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    hypoglycaemia in past two years 12 years 8/25 36%
    (16% to 56%)
    ketoacidosis in past two years 12 years 5/25 23%
    (5.2% to 40%)
    death 12 years 3/25 14%
    (0% to 28%)

    Comments

    1. Patients lost to follow-up or who died early were excluded from the analysis.
    2. Patients in 1978-9, the period of the study, were being managed without the availability of glycated haemoglobin values and in most cases probably with little or no self-glucose monitoring. It might be anticipated that frequency and severity of diabetic ketoacidosis episodes is considerably less frequent today.
    3. The most interesting observation is that female teenagers had the highest risk (incidence rate of 0.134) of developing diabetic ketoacidosis of any group. This observation remains consistent with similar observations today.

    Citation

    1. Tattersall R, Gregory R, Selby C, et al: Course of brittle diabetes: 12 year follow-up. British Medical Journal 1991; 302: 1240-1243
    Contributor: Chris Ball and Musab Hayatli, July 2000
    Reviewer:

    Clinical Question.
    Patient brittle diabetes
    Intervention or Exposure prevalence
    Outcome ketoacidosis and hypoglycaemia