• Maly Keler, Pavel Vlasov, Matan Elkan, Shlomit Koren, and Ronit Koren.
• Department of Internal Medicine A, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel.
• Isr Med Assoc J. 2024 Oct 1; 26 (9): 566571566-571.

BackgroundDiabetic ketoacidosis (DKA) poses a significant medical emergency in both type 1 (T1DM) and type 2 diabetes mellitus (T2DM) patients. Recent attention has focused on the emergence of euglycemic DKA associated with sodium-glucose cotransporter-2 (SGLT2) inhibitors.ObjectivesTo understand the epidemiology and outcomes of DKA, particularly in T2DM patients.MethodsWe conducted a retrospective cohort analysis of 204 patients admitted with DKA to Shamir Medical Center (2013-2021). We assessed demographics, clinical characteristics, and outcomes. Patients were stratified by diabetes type and SGLT2 inhibitor treatment status.ResultsAmong the 204 patients with DKA, 38.2% had T2DM. Patients with T2DM exhibited older age, higher co-morbidity burden, and greater prevalence of microvascular complications compared to T1DM patients. Mortality rates were notably higher among T2DM patients, despite similar DKA severity at presentation, including in-hospital mortality rates of 6.4% vs. 0%, P < 0.05, and 90-day mortality rates of 7.7% vs. 0%, P < 0.05. T2DM was independently associated with adverse hospitalization outcomes, including a composite of rehospitalization, prolonged hospital stays, and mortality (odds ratio 2.68, 95% confidence interval 1.302-5.557). SGLT2 inhibitor treatment did not affect hospitalization outcomes of patients with T2DM.ConclusionsOur findings underscore the importance of recognizing DKA as a substantial complication in diabetic patients, particularly those with T2DM. Vigilance in management, adherence to DKA guidelines, and awareness of triggers such as SGLT2 inhibitors are crucial for improving outcomes in this population.

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