Impact of ketoacidosis on long-term outcomes and quality of life in patients with type 1 diabetes mellitus: a retrospective study

Introduction. There is a rapid increase in the prevalence of type 1 diabetes every year around the world. Often the course of this disease is complicated by the development of diabetic ketoacidosis, which significantly worsens the patient’s long-term prognosis. Aim: To study a cohort of patients with type 1 diabetes mellitus depending on the presence or absence of diabetic ketoacidosis. To compare patient outcomes and quality of life depending on the occurrence of diabetic ketoacidosis in patients with type 1 diabetes mellitus.

Material and Methods. The data of 502 patients hospitalized at the V.V.Vinogradov State Clinical Hospital for the decompensation of type 1 diabetes mellitus for the period from 2022 to 2023 were retrospectively analyzed. Clinical and anamnestic data, the results of instrumental (echocardiography and chest X-ray) examinations were evaluated, the presence or absence of diabetic ketoacidosis was established. In the long-term period, the life status of patients was established by telephone contact with the patient or his relative, and the quality of life was assessed based on the Short Form-36 questionnaire.

Results. Median time of life quality and relapses observation after discharge was 18.5 [12.4; 24.0] months. Depending on the presence or absence of diabetic ketoacidosis, patients were divided into 2 groups: the group of patients with diagnosed diabetic ketoacidosis (DKA+) included 206 patients, the group of patients without signs of ketoacidosis (DKA-) – 296 patients. Clinically, patients in the DKA+ group were younger, males were more common, and disease duration was shorter compared to the DKA– group. Telephone contact was established with 84,5% (n = 174) of patients in the DKA+ group and 82.1% (n = 243) of patients in the DKA– group. The development of a fatal outcomes was noted in 1.9% (n = 4) of cases in the DKA+ group and 1.0% (n = 3) of cases in the DKA– group (p = 0.40). According to the results of the Short Form-36 questionnaire, there were no significant differences in the assessments of the physical and mental components of health between the groups (p > 0.05).

Conclusion. Long-term outcomes in patients with type 1 diabetes mellitus and diabetic ketoacidosis were comparable to those in patients without a history of diabetic ketoacidosis. Previous diabetic ketoacidosis does not have a significant negative impact on the quality of life of patients in the long term in our trial.

1. Anciferov M.B., Koteshkova O.M., Klejmenova S.A. Initiation of therapy using an insulin pump in patients with type 1 diabetes mellitus. Farmateka. 2011;216(3):30–37. (In Russ.). EDN: NTWRPN.

2. Eisenbarth G.S. Type I diabetes mellitus. A chronic autoimmune disease. 1986;314(21):1360–1368. https://doi.org/10.1056/NEJM198605223142106.

3. Maksimova E.G., Bondar' I.A. Decompensation of type 1 diabetes and frequency of late vascular complications. Siberian medical review. 2010;64(4):81–85. (In Russ.). EDN: MTBGKL.

4. Goncharova O.V., Zimina N.V., Devishev R.I. The importance of «Diabetes Schools» in the prevention of diabetes mellitus and its complications in children and adults. RMJ. 2012;20(20):1001–1007. (In Russ.). EDN: PMYIHN.

5. Umpierrez G., Korytkowski M. Diabetic emergencies – ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nature Reviews Endocrinology. 2016;12(4):222–232. https://doi.org/10.1038/nrendo.2016.15.

6. Nyenwe E.A., Kitabchi A.E. The evolution of diabetic ketoacidosis: An update of its etiology, pathogenesis and management. Metabolism. 2016;65(4):507–521. https://doi.org/10.1016/j.metabol.2015.12.007.

7. Foster N.C., Beck R.W., Miller K.M., Clements M.A., Rickels M.R., DiMeglio L.A. et al. State of type 1 diabetes management and outcomes from the T1D exchange in 2016–2018. Diabetes technology & therapeutics. 2019;21(2):66–72. https://doi.org/10.1089/dia.2018.0384.

8. Michaelis M., Shochat T., Shimon I., Akirov A. Features and long-term outcomes of patients hospitalized for diabetic ketoacidosis. Diabetes/ metabolism research and reviews. 2021;37(6):e3408. https://doi.org/10.1002/dmrr.3408.

9. Bykov Yu.V. Diabetic ketoacidosis in children and adolescents: from pathophysiology to prevention. Zabajkalʹskij medicinskij vestnik. 2021;2:85–95. (In Russ.). https://doi.org/10.52485/19986173_2021_2_85.

10. Hurtado C.R., Lemor A., Vallejo F., Lopez K., Garcia R., Mathew J. et al. Causes and predictors for 30-day re-admissions in adult patients with diabetic ketoacidosis in the united states: a nationwide analysis, 2010–2014. Endocrine Practice. 2019;25(3):242–253. https://doi.org/10.4158/EP-2018-0457.

11. Gibb F.W., Teoh W.L., Graham J., Lockman K.A. Risk of death following admission to a UK hospital with diabetic ketoacidosis. Diabetologia. 2016;59(10):2082–2087. https://doi.org/10.1007/s00125-016-4034-0.

12. Dedov I.I., Shestakova M.V., Mayorov A.Y., Shamkhalova M.S., Nikonova T.V., Sukhareva O.Y. et al. Diabetes mellitus type 1 in adults. Diabetes mellitus. 2020;23(1S):42–114. (In Russ.). https://doi.org/10.14341/DM12505.

13. Ware Jr. J.E., Sherbourne C.D. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical care. 1992;30(6):473–83. PMID: 1593914.

14. Azevedo L.C., Choi H., Simmonds K., Davidow J., Bagshaw S.M. Incidence and long-term outcomes of critically ill adult patients with 17.18.19.20. moderate-to-severe diabetic ketoacidosis: retrospective matched cohort study. Journal of critical care. 2014;29(6):971–977. https://doi.org/10.1016/j.jcrc.2014.07.034.

15. Nunes R.T.L., Mota C.F.M.G.P., Lins P.R.G., Reis F.S., Resende T.C.F., Barberino L.A. et al. Incidence, characteristics and long-term outcomes of patients with diabetic ketoacidosis: a prospective prognosis cohort study in an emergency department. Sao Paulo Medical Journal. 2021;139(1):10–17. https://doi.org/10.1590/1516-3180.2020.0285.R1.21102020.

16. Putula E., Huhtala H., Vanhamäki S., Laatikainen T., Tahkola A., Hannula P. et al. Clinical characteristics and prognoses of patients with diabetic ketoacidosis in Finland. Diabetes Epidemiology and Management. 2023;10:100129. https://doi.org/10.1016/j.deman.2023.100129.

17. Budhram D.R., Bapat P., Bakhsh A., Abuabat M.I., Verhoeff N.J., Mumford D. et al. Prognostic implications of diabetic ketoacidosis in adults on long-term mortality and diabetes-related complications. Canadian Journal of Diabetes. 2024;48(7):462–470.e3. https://doi.org/10.1016/j.jcjd.2024.07.002.

18. Golbets E., Brandstaetter E., Sagy I., Zimhony-Nissim N., Lipnitzki I., Musa H. et al. Predictors and outcomes of recurrent diabetic ketoacidosis in Israeli adults. Diabetes Metab Syndr. 2021;15(5):102276. https://doi.org/10.1016/j.dsx.2021.102276.

19. Alonso J., Ferrer M., Gandek B., Ware Jr. J.E., Aaronson N.K., Mosconi P. et al. Health-related quality of life associated with chronic conditions in eight countries: results from the International Quality of Life Assessment (IQOLA) Project. Qual. Life Res. 2004;13(2):283–298. https://doi.org/10.1023/b:qure.0000018472.46236.05.

20. Randall L., Begovic J., Hudson M., Smiley D., Peng L., Pitre N. et al. Recurrent diabetic ketoacidosis in inner-city minority patients: behavioral, socioeconomic, and psychosocial factors. Diabetes Care. 2011;34(9):1891–1896. https://doi.org/10.2337/dc11-0701.