Characteristics of severe diabetic ketoacidoses occurring before and after 60 years of age
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Older adults with severe diabetic ketoacidosis (DKA) face higher mortality risks. This study found significant differences in biochemical parameters and treatment needs in patients over 60, highlighting the need for age-specific DKA management strategies.
Area of Science:
- Endocrinology
- Geriatrics
- Internal Medicine
Background:
- Severe diabetic ketoacidosis (DKA) is a critical complication of diabetes.
- Age is a significant factor influencing DKA presentation and outcomes.
- Understanding age-related differences in DKA is crucial for effective treatment.
Purpose of the Study:
- To compare the clinical characteristics, biochemical parameters, treatment, and outcomes of severe DKA in patients under and over 60 years of age.
- To identify age-specific risk factors and management considerations for severe DKA.
Main Methods:
- Retrospective analysis of 459 severe DKA cases admitted to an Intensive Care Unit between 1978 and 1982.
- Comparison of biochemical data, fluid administration, insulin requirements, and mortality rates between patients under 60 and those 60 years or older.
- Statistical analysis to determine significant differences between the two age groups.
Main Results:
- Patients over 60 exhibited higher plasma sodium, potassium, and osmolarity, with a greater frequency of hypernatremic hyperosmolarity.
- Older patients required less intravenous fluid but higher insulin doses (236 U/24h vs. 182 U/24h).
- Mortality rates were significantly higher in patients over 60 (6.9%) compared to those under 60 (1.3%).
Conclusions:
- Severe DKA presents differently in older adults, with distinct biochemical profiles and increased mortality risk.
- Age-specific management protocols may be necessary to improve outcomes for elderly DKA patients.
- Infections remain the primary precipitating factor for DKA across all age groups.
Abstract:
Between 1978 and 1982, 459 cases of severe diabetic ketoacidosis (pH less than or equal to 7.20, total -CO2 less than or equal to 10 mMol/l) were admitted to our Intensive Care Unit. 416 (241 males, 175 females) were under 60 years (41 +/- 7) and 43 (22 males, 21 females) exceeded 60 years of age (67 +/- 7). The precipitating causes were fairly similar, in both groups, with infections foremost (68%). Presenting biochemical parameters, before and after 60 years showed differences in: blood glucose: 32.7 +/- 12 versus 34.8 +/- 8.1 mMol/l; plasma sodium 137 +/- 14 versus 143 +/- 16 mMol/l; plasma potassium 4.2 +/- 0.9 versus 4.9 +/- 0.7 mMol/l; hydrogen ion concentration 95 +/- 17 versus 73 +/- 12 mMol/l, (p less than 0.01); plasma osmolarity 327 +/- 98 versus 379 +/- 96 mOsm/l. The difference was significant (p less than 0.01) in frequency of hypernatremic hyperosmolarity (initial sodium greater than 147 mMol/l): 7.4% of 202 cases before age 60 years versus 24.1% of 29 case after age 60 years. The fluid amounts administered i.v. within the first 24 h was greater before (7516 +/- 2121 ml; p less than 0.01) than after 60 years (5276 +/- 1132 ml); insulin requirements were greater after 60 years (236 +/- 78 U/24 h; p less than 0.01) than before the age of 60 years (182 + 59 U/24 h). The mortality rate in the course of severe diabetic ketoacidoses was significantly lower before 60 years (1.3%, p less than 0.01) as against 6.9% after age 60 years.(ABSTRACT TRUNCATED AT 250 WORDS)