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Epidemiology/Health services research
Causes of diabetic ketoacidosis among adults with type 1 diabetes mellitus: insulin pump users and non-users
  1. Monica Flores1,
  2. Maryam Amir1,2,
  3. Ramsha Ahmed1,
  4. Suleiman Alashi1,
  5. Manshi Li3,
  6. Xiaofeng Wang3,
  7. M Cecilia Lansang4,5,
  8. Mohammed J Al-Jaghbeer6
  1. 1Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2Endocrinology Department, Case Western Reserve University, Cleveland, Ohio, USA
  3. 3Department of Medicine, Epidemiology, and Biostatics Department of Quantitative Health Science, Cleveland Clinic, Cleveland, Ohio, USA
  4. 4Diabetes and Metabolism, Cleveland Clinic, Cleveland, Ohio, USA
  5. 5Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
  6. 6Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Mohammed J Al-Jaghbeer; aljaghm{at}ccf.org

Abstract

Introduction Insulin pumps are increasingly being used as a method of insulin delivery in patients with type 1 diabetes mellitus (T1DM). Diabetic ketoacidosis (DKA) is a serious complication of T1DM. This study aims to identify the causes of DKA in patients with T1DM on continuous subcutaneous insulin infusion (CSII) and to compare these with patients with T1DM on multiple daily insulin injections (MDIIs).

Research design and methods This is a prospective observational study between January and June 2019 at the Cleveland Clinic Fairview Hospital. Demographic, clinical, and biochemical data were obtained from chart review. A questionnaire to explore additional clinical data relating to DKA was administered, with additional items for patients on the insulin pump.

Results Seventy-four patients were admitted with a diagnosis of DKA between the period of January and June 2019. Of these, 45 met the inclusion criteria and 43 consented. These were divided into two groups: group 1 included patients on MDII and group 2 included CSII. Overall, the most common precipitating factor for developing DKA was insulin non-adherence, seen in 51.2% of the cases. The most common cause of DKA in group 2 was pump/tubing related to 55% of the cases.

Conclusion Despite non-adherence being common in both CSII and MDII, a combination of social factors, education and insulin pump malfunction, such as pump/tubing problems, might be playing a pivotal role in DKA etiology in young adults with T1DM, especially in CSII users. Continued education on pump use may reduce the rate of DKA in pump users.

  • DKA
  • insulin pump
  • insulin-deficient type 1 diabetes
  • adults
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjdrc-2020-001329

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    Footnotes

    • Contributors MF organized and collected data, drafted and revised the paper. MA designed study protocol, data collection tools, and monitored data collection. SA designed study protocol, data collection tools, and monitored data collection. RA did data collection. ML analyzed the data and wrote the statistical plan. XW analyzed the data and wrote the statistical plan. MCL designed the study protocol, data collection tools, monitored data collection for the whole study, and drafted and revised the paper. MJA-J designed the study protocol, data collection tools, monitored data collection for the whole study, and drafted and revised the paper.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The Cleveland Clinic Institutional Review Board (IRB) reviewed and approved the study. IRB confirmation number 17–1680.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplemental information. All data is available on REDCap, will be available on request.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.