Clinical profiles of hyperglycemic crises: A single‐center retrospective study from Japan. Issue 8 (8th January 2021)

• Record Type: Journal Article
• Authors: Nishikawa, Takeshi; Kinoshita, Hiroyuki; Ono, Keiko; Kodama‐Hashimoto, Shoko; Kobayashi, Yuka; Nakamura, Tomofumi; Yoshinaga, Tomoaki; Ohkubo, Yuma; Harada, Masahiro; Toyonaga, Tetsushi; Takahashi, Takeshi; Araki, Eiichi
• Is Part Of: Journal of diabetes investigation. Volume 12:Issue 8(2021)
• Page Start: 1359
• Page End: 1366
• Publication Date: 2021-01-08
• Subjects: Coagulation disorders -- Diabetic ketoacidosis -- Hyperglycemic hyperosmotic syndrome; Diabetes -- Periodicals; Diabetes -- Research -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462005
• DOI: 10.1111/jdi.13475
• Languages: English
• ISSNs: 2040-1116

Abstract

Abstract: Aims/Introduction: The aim of the present study was to clarify the pathophysiologies of hyperglycemic crises in Japanese patients. Materials and Methods: This was a retrospective study of patients with hyperglycemic crises admitted to Kumamoto Medical Center, Kumamoto, Japan, between 2012 and 2019. Patients were classified as having diabetic ketoacidosis (DKA), hyperglycemic hyperosmotic syndrome (HHS) or a mixed state of the two conditions (MIX), and laboratory data and levels of consciousness at hospital admission, as well as the rates of mortality and coagulation disorders, were compared. Results: The diagnostic criteria for hyperglycemic crisis were met in 144 cases, comprising 87 (60.4%), 38 (26.4%) and 19 (13.2%) cases of DKA, HHS and MIX, respectively. Type 1 diabetes was noted in 46.0 and 26.3% of patients in the DKA and MIX groups, respectively. Fibrin degradation product and D‐dimer levels were significantly higher in the HHS group than in the DKA group (DKA and HHS groups: fibrin degradation product 7.94 ± 8.43 and 35.54 ± 51.80 μg/mL, respectively, P < 0.01; D‐dimer 2.830 ± 2.745 and 14.846 ± 21.430 μg/mL, respectively, P < 0.01). Mortality rates were 5.7, 13.2 and 5.3% in the DKA, HHS and MIX groups, respectively. Seven patients (4.9%), four of whom were in the MIX group, had acute arterial occlusive diseases. Conclusions: The low frequency of type 1 diabetes in DKA and MIX might be responsible for reduced insulin secretion in Japanese populations. Patients with hyperglycemic crises have increased coagulability, and acute arterial occlusion needs to be considered, particularly in MIX. Abstract : We carried out a retrospective analysis of patients with hyperglycemic crises who were treated in our hospital between 2012 and 2019 ( n = 144), because the pathologies of hyperglycemic crisis appear to be influenced by racial differences. The frequency of type 1 diabetes in Japanese patients with diabetic ketoacidosis and a mixed state of diabetic ketoacidosis and hyperglycemic hyperosmotic syndrome was lower than in white people. Patients with hyperglycemic hyperosmotic syndrome and a mixed state of diabetic ketoacidosis and hyperglycemic hyperosmotic syndrome showed increased coagulability, and patients with a mixed state of diabetic ketoacidosis and hyperglycemic hyperosmotic syndrome had a significantly higher incidence of acute arterial occlusive disease than patients with diabetic ketoacidosis and hyperglycemic hyperosmotic syndrome.