Clinical and Biochemical Characteristics of Adult Diabetic Ketoacidosis: T1DM vs. T2DM
https://doi.org/10.15605/jafes.041.S1
- Author:
Mohd Fyzal Bahrudin
1
;
Chin Voon Tong
1
;
Raja Nurazni Raja Azwan
1
;
Adilah Zulaikha Abd Latib
1
;
idayatil Alimi Keya Nordin
1
;
Qin Zhi Lee
1
;
Kean Heng Lim
1
;
Jia Ling Low
1
;
Syaza Izhar Hisham
1
;
Liang Wei Wong
1
;
Jia Whey Jacelyn Ong
2
;
Lisa Mohamed Nor
1
;
Zanariah Hussein
1
Author Information
1. Endocrine Unit, Medical Department, Hospital Putrajaya
2. Clinical Research Centre, Hospital Putrajaya
- Publication Type:Journal Article
- MeSH:
Adult;
Diabetes Mellitus, Type 1;
Diabetic Ketoacidosis;
Diabetes Mellitus, Type 2
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):39-40
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:The rising incidence of diabetic ketoacidosis (DKA) in type 2
diabetes mellitus (T2DM) represents a paradigm shift from
its traditional recognition as a hallmark complication of
type 1 diabetes mellitus (T1DM). However, contemporary
data comparing clinical presentation, precipitating factors,
and outcomes between these two populations remain
limited.
Methodology:In this retrospective observational study, all adult DKA
admissions with T1DM or T2DM at a tertiary centre between
2001 and 2025 were studied. DKA was defined according
to standard biochemical criteria. Electronic medical records were reviewed to extract demographic data, biochemical
parameters, precipitating factors, management details, and
clinical outcomes of all adult DKA admission in T1DM and
T2DM. Patients aged <18 years or those with incomplete
data were excluded.
Results:A total of 601 DKA episodes were analyzed, comprising
130 (21.6%) in patients with T1DM and 471 (78.4%) in those
with T2DM. Mean age was 26.9 ± 0.71 years for T1DM and
52.1 ± 0.7 years for T2DM. Gender distribution was balanced
(male 48.3%, female 51.7%). Mean hemoglobin A1c (HbA1c)
was 11.3 ± 0.3% in T1DM and 12.1 ± 0.2% in T2DM. Infection
was the most common precipitating factor overall (69.0%),
occurring more frequently in T2DM than in T1DM (74.7%
vs. 56.2%), followed by medication non-adherence (62.4%
vs. 43.8%). Significant differences were observed between
groups in admission pH, bicarbonate (both p <0.001), blood
ketones (p = 0.028), and HbA1c (p = 0.010), whereas anion
gap (p = 0.056) and blood glucose levels (p = 0.755) did not
differ significantly. Clinical outcomes were comparable
with respect to intensive care unit (ICU) admission rates
(40.0% in T1DM vs. 39.0% in T2DM, p = 0.779) and median
resolution time (p = 0.462). However, the median length of
hospital stay was significantly longer in T2DM (8.2 ± 0.32
vs. 5.4 ± 0.4 days; p <0.001). Overall mortality was 6.0%,
with substantially higher mortality in T2DM compared to
T1DM (7.4% vs. 0.8%, p = 0.013).
Conclusion:In this large regional series of adult DKA, most episodes
occurred in T2DM. Despite similar ICU admission rates
and time to resolution, T2DM was associated with more
frequent infection-related precipitants, longer hospital
stays, and higher mortality, underscoring the need for
targeted preventive strategies in this population.
- Full text:2026072916213679126EP_A038.pdf
