Secondary diabetic ketoacidosis and severe hypoglycaemia in patients with established type 1 diabetes mellitus in China: a multicentre registration study

Diabetes Metab Res Rev. 2014 Sep;30(6):497-504. doi: 10.1002/dmrr.2547.

Abstract

Background: Diabetic ketoacidosis (DKA) and severe hypoglycaemia are common acute complications of type 1 diabetes mellitus (T1DM). This study aimed to determine the incidence of, and risk factors for, these complications in Chinese patients with established T1DM.

Methods: This cross-sectional study recruited patients with established T1DM from 16 centres in Guangdong Province, China. Incidence rates were expressed as episodes/100 patient-years. Regression models identified risk factors for the occurrence and recurrence of secondary DKA and severe hypoglycaemia.

Results: A total of 611 patients with established T1DM (53.7% women) were recruited. The incidence of secondary DKA and severe hypoglycaemia was 26.4 (22.4, 31.0) and 68.8 (62.2, 76.0)/100 patient-years, respectively. Significant risk factors for secondary DKA were female gender [relative risk (RR) = 2.12], medical reimbursement rate <50% (RR = 1.84), uncontrolled diet (RR = 1.76), smoking (RR = 2.18) and poor glycaemic control [glycated haemoglobin A1c (HbA1c)/1.0% increase; RR = 1.15]. Overweight/obesity was a protective factor (RR = 0.57). Significant risk factors for severe hypoglycaemia included male gender (RR = 1.71), medical reimbursement rate < 50% (RR = 1.36), longer duration of T1DM (per 5-year increase, RR = 1.22), underweight (RR = 1.44), uncontrolled diet ('never controlled' or 'sometimes controlled' vs. 'usually controlled', RR = 2.09 or 2.02, respectively), exercise <150 min/week (RR = 1.66), presence of neuropathy (RR = 1.89), smoking (RR = 1.48) and lower HbA1c values (per 1.0% decrease, RR = 1.46). Overweight/obesity was a protective factor (RR = 0.62). Additionally, 34.4% of secondary DKA and 81.1% of severe hypoglycaemia episodes occurred in 3.8% and 16.2% patients with recurrent events (≥two episodes), respectively.

Conclusions: The results indicate that secondary DKA and severe hypoglycaemia occur at high rates in Chinese patients with established T1DM and that recurrence is likely to occur in high-risk patients. Comprehensive management of T1DM should include recommendations to control modifiable risk factors.

Keywords: Chinese; diabetes mellitus; diabetic ketoacidosis; incidence; risk factors; severe hypoglycaemia; type 1.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • China / epidemiology
  • Combined Modality Therapy / economics
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / economics
  • Diabetes Mellitus, Type 1 / physiopathology*
  • Diabetes Mellitus, Type 1 / therapy
  • Diabetic Ketoacidosis / economics
  • Diabetic Ketoacidosis / epidemiology*
  • Diabetic Ketoacidosis / etiology
  • Diabetic Ketoacidosis / physiopathology
  • Female
  • Glycated Hemoglobin / analysis
  • Humans
  • Hypoglycemia / economics
  • Hypoglycemia / epidemiology*
  • Hypoglycemia / etiology
  • Hypoglycemia / physiopathology
  • Incidence
  • Insurance, Health, Reimbursement
  • Male
  • Middle Aged
  • Pilot Projects
  • Risk Factors
  • Severity of Illness Index
  • Sex Characteristics
  • Smoking / adverse effects
  • Young Adult

Substances

  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human