Background/Objectives: Diabetic ketoacidosis (DKA) is a life-threatening emergency resulting in significant morbidity and health care utilization. The most common cause of DKA in the general population is insulin nonadherence, but limited data exists on precipitating factors for DKA in cancer patients. In this study, we characterize the demographic and clinical characteristics of hospitalized patients with DKA at our comprehensive cancer center. Methods: This single-center retrospective study evaluated 91 patients with 94 admissions for DKA at our institution between January 2019 and December 2021. Demographic, clinical, and biochemical data were obtained from a review of the electronic medical record. Patient characteristics were summarized using descriptive statistics for continuous variables and categorical variables. Results: Of the 91 patients, 21% of patients (n= 19) had underlying type 1 diabetes, 49% of patients (n= 45) had type 2 diabetes, and 30% of patients (n= 27) had drug-induced diabetes. A total of 39% (n= 29) had poorly controlled diabetes with HbA1c > 9% (75 mmol/mol). In patients with known type 1 diabetes, the most common provoking factors were inadequate insulin therapy and infection related causes. In patients with known type 2 diabetes or no previous history of diabetes, the most common provoking factors were medications such as immune checkpoint inhibitors, SGLT2 inhibitors and steroids. Conclusions: We characterized the precipitating factors for DKA based on patients’ underlying diabetes status. While insulin non-adherence was the most common cause in patients with known type 1 diabetes, drugs associated with cancer related treatments emerged most common precipitating factor for DKA in cancer patients with underlying type 2 diabetes or drug induced diabetes. A tailored approach with proactive counseling may be helpful in timely recognition and treatment of DKA in cancer patients.
背景/目的：糖尿病酮症酸中毒是一种危及生命的急症，可导致显著的发病率和医疗资源消耗。在普通人群中，DKA最常见的原因是胰岛素治疗依从性差，但关于癌症患者DKA诱发因素的数据有限。本研究旨在描述我们综合性癌症中心住院DKA患者的人口学和临床特征。方法：这项单中心回顾性研究评估了2019年1月至2021年12月期间我院91例患者（共94次入院）的DKA病例。通过查阅电子病历获取人口统计学、临床和生化数据。采用描述性统计方法对连续变量和分类变量进行患者特征总结。结果：在91例患者中，21%（n=19）患有基础1型糖尿病，49%（n=45）患有2型糖尿病，30%（n=27）为药物诱导性糖尿病。总计39%（n=29）的患者糖尿病控制不佳（HbA1c > 9% [75 mmol/mol]）。在已知1型糖尿病患者中，最常见的诱发因素是胰岛素治疗不足和感染相关原因。在已知2型糖尿病或无既往糖尿病史的患者中，最常见的诱发因素是药物，如免疫检查点抑制剂、SGLT2抑制剂和类固醇。结论：我们根据患者的基础糖尿病状况，明确了DKA的诱发因素。在已知1型糖尿病患者中，胰岛素治疗不依从是最常见原因；而在基础为2型糖尿病或药物诱导性糖尿病的癌症患者中，与癌症治疗相关的药物成为DKA最常见的诱发因素。采取针对性方法并进行主动宣教，可能有助于癌症患者DKA的及时识别和治疗。
Etiologies and Outcomes of Diabetic Ketoacidosis in Cancer Patients: A Retrospective Analysis
肿瘤(癌症)患者之家