背景:随着基于证据的协议和资源的可用性,DKA的预后随着时间的推移而有所改善。然而,在肯尼亚,DKA的适当诊断和管理资源有限,主要限于三级转诊设施。本研究旨在回顾临床表现,管理,和接受DKA的成年患者的结局,并评估COVID-19大流行之前和期间这些参数的差异。
方法:这是一项2017年1月至2021年12月DKA入院的回顾性研究。使用ICD-10代码从病历部门检索患者数据,并在临床表现上提取个人细节,管理,以及DKA的结果。在COVID-19之前和COVID-19持续时间之间进行了比较。
结果:纳入了150例DKA患者(n=48,COVID-19之前,n=102(n=23COVID-19阳性,n=79COVID-19阴性))。中位年龄为47岁(IQR33.0,59.0),HbA1C中位数为12.4%[IQR10.8,14.6]),大多数患者有严重的DKA(46%)。最常见的DKA沉淀剂是感染(40.7%),新诊断的糖尿病(33.3%)和错过药物治疗(25.3%)。作为DKA沉淀剂,肺部感染有显著差异,在COVID-19大流行前和COVID-19大流行期间(COVID-19期间为21.6%,COVID-19之前为6.3%;p=0.012)。使用的总胰岛素剂量中位数为110.0单位[IQR76.0,173.0],100%的患者接受了基础胰岛素。住院时间中位数为4.0天[IQR3.0,6.0],DKA消退时间为30.0h[IQR24.0,48.0]。有2人死亡(1.3%),没有直接归因于DKA。在前COVID-19,COVID-19阳性和COVID-19阴性DKA之间,DKA的严重程度显着不同(COVID-19阳性的52.2%具有中度DKA,而COVID-19阴性的26.6%和前COVID-19的22.9%(p=0.006))。
结论:即使在发展中地区,使用适当的DKA管理设施可以取得良好的结果。临床医生和患者教育是必要的,以确保早期发现和及时转诊,以避免患者出现严重的DKA。需要进行探索性研究,以评估本研究中发现的DKA消退时间延长的原因。
BACKGROUND: Prognosis of
DKA has improved over time with the availability of evidence-based protocols and resources. However, in Kenya, there are limited resources for the appropriate diagnosis and management of
DKA, mostly limited to tertiary-level referral facilities. This study aimed to review the clinical presentation, management, and outcomes of adult patients admitted with
DKA and assess differences in these parameters before and during the COVID-19 pandemic.
METHODS: This was a retrospective study of DKA admissions from January 2017 to December 2021. Patient data were retrieved from the medical records department using ICD-10 codes, and individual details were abstracted on clinical presentation, management, and outcomes of DKA. Comparisons were made between pre-COVID-19 and during COVID-19 durations.
RESULTS: 150 patients admitted with DKA were included (n = 48 pre- COVID-19, n = 102 during COVID-19 (n = 23 COVID-19 positive, n = 79 COVID-19 negative)). Median age was 47 years (IQR 33.0, 59.0), median HbA1C was 12.4% [IQR 10.8, 14.6]), and most patients had severe DKA (46%). Most common DKA precipitants were infections (40.7%), newly diagnosed diabetes (33.3%) and missed medication (25.3%). There was a significant difference in pulmonary infections as a DKA precipitant, between the pre- COVID and during COVID-19 pandemic (21.6% during COVID-19 versus 6.3% pre- COVID-19; p = 0.012). Median total insulin dose used was 110.0 units [IQR 76.0, 173.0], and a 100% of patients received basal insulin. Median length of hospital stay was 4.0 days [IQR 3.0, 6.0] and time to DKA resolution was 30.0 h [IQR 24.0, 48.0]. There were 2 deaths (1.3%), none directly attributable to
DKA. Severity of DKA significantly differed between pre- COVID-19, COVID-19 positive and COVID-19 negative
DKA (52.2% of COVID-19 positive had moderate
DKA compared to 26.6% of COVID-19 negative and 22.9% of Pre-COVID-19 (p = 0.006)).
CONCLUSIONS: Even in developing regions, good outcomes can be achieved with the appropriate facilities for DKA management. Clinician and patient education is necessary to ensure early detection and prompt referral to avoid patients presenting with severe DKA. Exploratory studies are needed to assess reasons for prolonged time to DKA resolution found in this study.