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Diabetic ketosis during hyperglycemic crisis is associated with decreased all-cause mortality in patients with type 2 diabetes mellitus.
Endocrine. 2017 Jan; 55(1):139-143.E

Abstract

Patients with type 2 diabetes mellitus have impaired ketogenesis due to high serum insulin and low growth hormone levels. Evidence exists that ketone bodies might improve kidney and cardiac function. In theory, improved ketogenesis in diabetics may have positive effects. We aimed to assess the impact of diabetic ketosis on all-cause mortality in patients with type 2 diabetes mellitus presenting with hyperglycemic crisis. We analyzed 486 patients with diabetic ketosis and 486 age and sex-matched patients with non-ketotic hyperglycemia presenting to the emergency department. Cox proportional hazard models were used to analyze the link between patient characteristics and mortality. During an observation time of 33.4 months, death of any cause occurred in 40.9 % of the non-ketotic hyperglycemia group and 30.2 % of the DK group (hazard ratio in the diabetic ketosis group, 0.63; 95 % confidence interval 0.48-0.82; P = 0.0005). Patients with diabetic ketosis had a lower incidence of symptomatic heart failure and had improved renal function. They used less furosemide and antihypertensive drugs, more metformin and lower insulin doses, all of which was independently associated with decreased mortality. Plasma glucose and glycated hemoglobin levels were similar in both groups. Patients with hyperglycemic crisis and diabetic ketosis have decreased all-cause mortality when compared to those with non-ketotic hyperglycemia. diabetic ketosis might be a compensatory mechanism rather than a complication in patients with hyperglycemic crises, but further prospective studies are warranted.

Authors+Show Affiliations

Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sestre Milosrdnice", University of Zagreb School of Medicine, Vinogradska cesta 29, Zagreb, 10000, Croatia. ivkruljac@gmail.com.Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sestre Milosrdnice", University of Zagreb School of Medicine, Vinogradska cesta 29, Zagreb, 10000, Croatia.University of Zagreb School of Medicine, Zagreb, Croatia.Department of Internal Medicine, University Hospital "Sveti Duh", Zagreb, Croatia.Clinical Institute of Chemistry, University Hospital Center "Sestre Milosrdnice", University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia.Department of Emergency Medicine, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia.Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sestre Milosrdnice", University of Zagreb School of Medicine, Vinogradska cesta 29, Zagreb, 10000, Croatia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27592119

Citation

Kruljac, Ivan, et al. "Diabetic Ketosis During Hyperglycemic Crisis Is Associated With Decreased All-cause Mortality in Patients With Type 2 Diabetes Mellitus." Endocrine, vol. 55, no. 1, 2017, pp. 139-143.
Kruljac I, Ćaćić M, Ćaćić P, et al. Diabetic ketosis during hyperglycemic crisis is associated with decreased all-cause mortality in patients with type 2 diabetes mellitus. Endocrine. 2017;55(1):139-143.
Kruljac, I., Ćaćić, M., Ćaćić, P., Ostojić, V., Štefanović, M., Šikić, A., & Vrkljan, M. (2017). Diabetic ketosis during hyperglycemic crisis is associated with decreased all-cause mortality in patients with type 2 diabetes mellitus. Endocrine, 55(1), 139-143. https://doi.org/10.1007/s12020-016-1082-7
Kruljac I, et al. Diabetic Ketosis During Hyperglycemic Crisis Is Associated With Decreased All-cause Mortality in Patients With Type 2 Diabetes Mellitus. Endocrine. 2017;55(1):139-143. PubMed PMID: 27592119.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diabetic ketosis during hyperglycemic crisis is associated with decreased all-cause mortality in patients with type 2 diabetes mellitus. AU - Kruljac,Ivan, AU - Ćaćić,Miroslav, AU - Ćaćić,Petra, AU - Ostojić,Vedran, AU - Štefanović,Mario, AU - Šikić,Aljoša, AU - Vrkljan,Milan, Y1 - 2016/09/03/ PY - 2016/07/03/received PY - 2016/08/08/accepted PY - 2016/9/7/pubmed PY - 2017/7/14/medline PY - 2016/9/5/entrez KW - Heart failure KW - Ketogenesis KW - Ketosis KW - Kidney disease KW - Mortality KW - Type 2 diabetes mellitus SP - 139 EP - 143 JF - Endocrine JO - Endocrine VL - 55 IS - 1 N2 - Patients with type 2 diabetes mellitus have impaired ketogenesis due to high serum insulin and low growth hormone levels. Evidence exists that ketone bodies might improve kidney and cardiac function. In theory, improved ketogenesis in diabetics may have positive effects. We aimed to assess the impact of diabetic ketosis on all-cause mortality in patients with type 2 diabetes mellitus presenting with hyperglycemic crisis. We analyzed 486 patients with diabetic ketosis and 486 age and sex-matched patients with non-ketotic hyperglycemia presenting to the emergency department. Cox proportional hazard models were used to analyze the link between patient characteristics and mortality. During an observation time of 33.4 months, death of any cause occurred in 40.9 % of the non-ketotic hyperglycemia group and 30.2 % of the DK group (hazard ratio in the diabetic ketosis group, 0.63; 95 % confidence interval 0.48-0.82; P = 0.0005). Patients with diabetic ketosis had a lower incidence of symptomatic heart failure and had improved renal function. They used less furosemide and antihypertensive drugs, more metformin and lower insulin doses, all of which was independently associated with decreased mortality. Plasma glucose and glycated hemoglobin levels were similar in both groups. Patients with hyperglycemic crisis and diabetic ketosis have decreased all-cause mortality when compared to those with non-ketotic hyperglycemia. diabetic ketosis might be a compensatory mechanism rather than a complication in patients with hyperglycemic crises, but further prospective studies are warranted. SN - 1559-0100 UR - https://www.unboundmedicine.com/medline/citation/27592119/Diabetic_ketosis_during_hyperglycemic_crisis_is_associated_with_decreased_all_cause_mortality_in_patients_with_type_2_diabetes_mellitus_ L2 - https://dx.doi.org/10.1007/s12020-016-1082-7 DB - PRIME DP - Unbound Medicine ER -