Characteristics of elderly patients with Diabetic Ketoacidosis

Yim, Hae Seang; Ihm, Sung Hee; Kim, Hyun Kyu; Kim, Doo Man; Yoo, Jae Myung; Choi, Moon Gi; Yoo, Byung Joon; Park, Sung Woo

Abstract

BACKGROUND: Diabetic ketoacidosis (DKA) is usually thought of as a condition of young, insulin-requiring diabetic patients. The clinical characteristics of older adults with DKA have not been well characterized. To characterize the elderly patients with DKA, we described how DKA in the elderly differs from that in the young adults.
METHODS
We analyzed the clinical data of 112 patients who were diagnosed DKA for the first time from July, 1987 to June, 1997 at Hallym Univ. Sacred Heart Hospitals. We divided our patients into 3 groups according to the age at the first DKA and compared the clinical characteristics of DKA patients aged 65 or over with those of under 30 of age.
RESULTS
Forty-four patients were under 30 of age and 8 patients were 65 or over of age. The duration of DM prior to DKA was 11.9+/-3.0 years in the elderly gouty and 1.6+/-0.4 years in the young group, and the debut DKA's were 12.5% and 47.7%, respectively. The elderly patients were less likely to have been using insulin before DKA (12.5% vs. 74%). The most frequent precipitating factor of DKA was 'infection' in the elderly group (50%) and 'unidentifiable' in the young group (46%). The elderly group showed the higher arterial pH (7.22+/-0.03 vs. 7.09+/-0.02), bicarbonate (10.9+/-1.5 vs. 5.1+/-0.7 mEq/L), and serum fasting C-peptide (0.37+/-0.08 vs. 0.19+/-0.04 nmol/L) levels, and the higher mortality rate (25% vs. 2.3%) compared with the young group.
CONCLUSION
The elderly patients with DKA showed the longer duration of DM and less debut DKA's, the less previous history of insulin-treatment, the higher proportion of infection as precipitating (actors, the higher arterial pH, bicarbonate, and serum fasting C-peptide levels, and the higher mortality rate compared with the young patients with DKA.