Etiologies and Outcomes of Diabetic Ketoacidosis in Cancer Patients: A Retrospective Analysis

Diabetic ketoacidosis (DKA) is a life-threatening emergency resulting in significant morbidity and health care utilization. The most common cause of DKA in the general population is insulin nonadherence, but limited data exists on precipitating factors for DKA in cancer patients. In this study, we characterize the demographic and clinical characteristics of hospitalized patients with DKA at our comprehensive cancer center.

This single-center retrospective study evaluated 91 patients with 94 admissions for DKA at our institution between January 2019 and December 2021. Demographic, clinical, and biochemical data were obtained from a review of the electronic medical record. Patient characteristics were summarized using descriptive statistics for continuous variables and categorical variables.

Of the 91 patients, 21% of patients (n = 19) had underlying type 1 diabetes, 49% of patients (n = 45) had type 2 diabetes, and 30% of patients (n = 27) had drug-induced diabetes. A total of 39% (n = 29) had poorly controlled diabetes with HbA1c > 9% (75 mmol/mol). In patients with known type 1 diabetes, the most common provoking factors were inadequate insulin therapy and infection related causes. In patients with known type 2 diabetes or no previous history of diabetes, the most common provoking factors were medications such as immune checkpoint inhibitors, SGLT2 inhibitors and steroids.

We characterized the precipitating factors for DKA based on patients' underlying diabetes status. While insulin non-adherence was the most common cause in patients with known type 1 diabetes, drugs associated with cancer related treatments emerged most common precipitating factor for DKA in cancer patients with underlying type 2 diabetes or drug induced diabetes. A tailored approach with proactive counseling may be helpful in timely recognition and treatment of DKA in cancer patients.