Diabetic ketoacidosis: comparisons of patient characteristics, clinical presentations and outcomes today and 20 years ago.

BACKGROUND The aim of this study was to compare the clinical manifestations and outcomes of patients with diabetic ketoacidosis (DKA) today and 20 years ago. METHODS A retrospective review was conducted of patients with DKA treated at our hospital from January 2001 through June 2002. The medical records were analyzed to identify clinical presentations, contributory factors, laboratory data, and outcomes. Additionally, data were compared with the records of patients with DKA in 1981 and 1982 at the same hospital. RESULTS Data on 132 patients with 148 DKA episodes were included in the present study. When compared with the data from 20 years ago, clinical presentations, precipitating factors and laboratory data were similar. However, the mortality rate markedly decreased from 7.96% to 0.67%. Among patients with documented bacterial infections, a significantly high prevalence (70%) of Klebsiella pneumoniae infection was discovered. In patients with recurrent DKA, young women with type 1 diabetes accounted for most of the cases (67%) due to the omission of insulin. Eleven of 49 patients (22%) with newly diagnosed diabetes presenting with DKA were not insulin dependent during the 1.5-year follow up. CONCLUSIONS After 20 years, the clinical presentations and precipitating factors of DKA were similar. However, the mortality rate was significantly reduced. Klebsiella pneumoniae was the leading cause of bacterial infections precipitating DKA in our hospital. Young women with type 1 diabetes were at high risk of repeat DKA.