Article Text

  1. E. Nyenwe*,
  2. R. Loganathan,
  3. S. Blum,
  4. D. Ezuteh,
  5. D. Erani,
  6. M. Palace,
  7. C. Ogugua,
  8. A. Kitabchi*
  1. Division of Endocrinology, Bronx Lebanon Hospital Center, Bronx, New York
  2. *University of Tennessee Health Science Center, Memphis, TN


Background Hospitalizations for diabetic ketoacidosis (DKA) are increasing, perhaps due to rising incidence of DKA in patients with type 2 diabetes (T2DM). Ethnic minority groups are at increased risk for T2DM. This study aimed at elucidating the characteristics of patients with ketosis-prone diabetes in a predominantly ethnic minority population.

Research Design and Methods We performed a retrospective analysis of sequential admissions of adults with DKA at the Bronx Lebanon Hospital Center (BLHC), Bronx, New York, between July 1, 2001 and June 30, 2004. The patients were divided into 2 major groups based on the type of diabetes and were further subclassified on the basis of their ethnicity. The groups were compared for different clinical and biochemical parameters using ANOVA and chi square tests.

Results There were 203 patients admitted with DKA [97% of whom were African American (AA) or Hispanic (H)] with mean age of 37.6 6 14.6 years. The patients consisted of 116 (57%) males. Seventy-two (36%) patients had T2DM. New-onset diabetes, which was more common in T2DM (p = .0002) and AA (p = .01), occurred in 52 patients (26%). Although the frequency of type 1 diabetes (T1DM) was equal in both the AA and H, readmission with DKA was more common in H (p = .001). T2DM was 1.5 times more prevalent in the AA than the H. Patients with T1DM had more severe DKA as shown by lower PH, bicarbonate levels, and larger anion gap (p = .04, .02, and .007, respectively). HbA1c level was higher in patients with new-onset diabetes (p = .02) but did not differ between T1DM and T2DM. Patients with T2DM had less identifiable precipitating factors than T1DM (p < .04). Mortality, which was less than 2%, occurred in the AA patients with T2DM.

Conclusions DKA may be more common in T2DM than is thought, especially among minority groups. DKA is an important mode of initial presentation of T2DM, especially in AA, who also appear to have a higher mortality rate. The rising incidence of DKA may be attributable to its increasing occurrence in T2DM; therefore, measures aimed at primary prevention of T2DM are necessary. The result of this study further highlights the heterogeneity of ketosis-prone diabetes and underscores the need for further studies.

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