Retrospective derivation of a causal pathway for diabetic ketoacidosis in adult patients with type 2 diabetes mellitus
Background Type 2 ketone-prone diabetes mellitus (T2KPDM) is thought to occur in men of African descent, with obesity who experienced prolonged hyperglycemia; the role of medication non-adherence as a contributing cause remains unstudied.Research design and methods This was a retrospective study of...
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| Format: | Article |
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BMJ Publishing Group
2024-12-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/12/6/e004595.full |
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| author | Robert D Welch Phillip D Levy Jeffrey A Kline Richard T Griffey Nicholas A Wesner Amina T Sharif George Grunberger |
| author_facet | Robert D Welch Phillip D Levy Jeffrey A Kline Richard T Griffey Nicholas A Wesner Amina T Sharif George Grunberger |
| author_sort | Robert D Welch |
| collection | DOAJ |
| description | Background Type 2 ketone-prone diabetes mellitus (T2KPDM) is thought to occur in men of African descent, with obesity who experienced prolonged hyperglycemia; the role of medication non-adherence as a contributing cause remains unstudied.Research design and methods This was a retrospective study of unique adults (>18 years) who sought emergency care one of four hospitals in the greater Detroit area. Patients were identified on the basis of a laboratory order for a ß-hydroxybutyrate concentration. Two research coordinators abstracted 119 data fields. Patients were divided into four phenotypes: (1) no prior DM, (2) type 2 DM without prior ketosis, (3) type 2 with prior ketosis and (4) type 1 DM. A ß-hydroxybutyrate >20 mg/dL defined diabetic ketoacidosis (DKA). A directed acyclic graph was constructed to diagram a causal pathway.Results Of 450 patients, 326 were non-type I and 37% of these had DKA. Concentrations of ß-hydroxybutyrate, glucose, bicarbonate were not different between non-type1 versus type 1 DM patients. Admission rates to the ICU and hospital lengths of stay were similar between the four phenotypes with DKA. We found no association with sex, race or body mass index. Unadjusted odds for DKA were significant for non-adherence (odds=1.74, 95% CI 1.08 to 2.21) arrival by Emergency Medical Services (odds=0.54, 95% CI 0.33 to 0.86) and private or Medicare insurance (odds=6.80, 95% CI 4.00 to 11.60). The median HbA1C was statistically higher in patients with DKA (median 11.3%) versus those without DKA (median 9.5%, Mann-Whitney U p<0.001) and was also higher in patients with a history of non-adherence. In multivariable analysis, non-adherence was found to be a mediator of DKA with T2KPDM.Conclusions in Detroit, MI, prior ketosis and private or Medicare health insurance were significantly associated with new or recurrent DKA in T2KPDM. Medication non-adherence had a mediating role. |
| format | Article |
| id | doaj-art-a2b498cfb7a244fc881b0b09d823d7b2 |
| institution | Kabale University |
| issn | 2052-4897 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Diabetes Research & Care |
| spelling | doaj-art-a2b498cfb7a244fc881b0b09d823d7b22024-12-24T16:25:10ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972024-12-0112610.1136/bmjdrc-2024-004595Retrospective derivation of a causal pathway for diabetic ketoacidosis in adult patients with type 2 diabetes mellitusRobert D Welch0Phillip D Levy1Jeffrey A Kline2Richard T Griffey3Nicholas A Wesner4Amina T Sharif5George Grunberger6Wayne State University School of Medicine, Detroit, Michigan, USADepartment of Emergency Medicine, Wayne State University, Detroit, USADepartment of Emergency Medicine, Wayne State University, Detroit, USADepartment of Emergency Medicine, Washington University School of Medicine, St. Louis, USADepartment of Emergency Medicine, Wayne State University, Detroit, USADepartment of Emergency Medicine, Wayne State University, Detroit, USAWayne State University School of Medicine, Detroit, Michigan, USABackground Type 2 ketone-prone diabetes mellitus (T2KPDM) is thought to occur in men of African descent, with obesity who experienced prolonged hyperglycemia; the role of medication non-adherence as a contributing cause remains unstudied.Research design and methods This was a retrospective study of unique adults (>18 years) who sought emergency care one of four hospitals in the greater Detroit area. Patients were identified on the basis of a laboratory order for a ß-hydroxybutyrate concentration. Two research coordinators abstracted 119 data fields. Patients were divided into four phenotypes: (1) no prior DM, (2) type 2 DM without prior ketosis, (3) type 2 with prior ketosis and (4) type 1 DM. A ß-hydroxybutyrate >20 mg/dL defined diabetic ketoacidosis (DKA). A directed acyclic graph was constructed to diagram a causal pathway.Results Of 450 patients, 326 were non-type I and 37% of these had DKA. Concentrations of ß-hydroxybutyrate, glucose, bicarbonate were not different between non-type1 versus type 1 DM patients. Admission rates to the ICU and hospital lengths of stay were similar between the four phenotypes with DKA. We found no association with sex, race or body mass index. Unadjusted odds for DKA were significant for non-adherence (odds=1.74, 95% CI 1.08 to 2.21) arrival by Emergency Medical Services (odds=0.54, 95% CI 0.33 to 0.86) and private or Medicare insurance (odds=6.80, 95% CI 4.00 to 11.60). The median HbA1C was statistically higher in patients with DKA (median 11.3%) versus those without DKA (median 9.5%, Mann-Whitney U p<0.001) and was also higher in patients with a history of non-adherence. In multivariable analysis, non-adherence was found to be a mediator of DKA with T2KPDM.Conclusions in Detroit, MI, prior ketosis and private or Medicare health insurance were significantly associated with new or recurrent DKA in T2KPDM. Medication non-adherence had a mediating role.https://drc.bmj.com/content/12/6/e004595.full |
| spellingShingle | Robert D Welch Phillip D Levy Jeffrey A Kline Richard T Griffey Nicholas A Wesner Amina T Sharif George Grunberger Retrospective derivation of a causal pathway for diabetic ketoacidosis in adult patients with type 2 diabetes mellitus BMJ Open Diabetes Research & Care |
| title | Retrospective derivation of a causal pathway for diabetic ketoacidosis in adult patients with type 2 diabetes mellitus |
| title_full | Retrospective derivation of a causal pathway for diabetic ketoacidosis in adult patients with type 2 diabetes mellitus |
| title_fullStr | Retrospective derivation of a causal pathway for diabetic ketoacidosis in adult patients with type 2 diabetes mellitus |
| title_full_unstemmed | Retrospective derivation of a causal pathway for diabetic ketoacidosis in adult patients with type 2 diabetes mellitus |
| title_short | Retrospective derivation of a causal pathway for diabetic ketoacidosis in adult patients with type 2 diabetes mellitus |
| title_sort | retrospective derivation of a causal pathway for diabetic ketoacidosis in adult patients with type 2 diabetes mellitus |
| url | https://drc.bmj.com/content/12/6/e004595.full |
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