This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (80)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Guillermo E. Umpierrez, MD; Jason P. Kelly; Jose E. Navarrete, MD; Mary M. C. Casals, MD; Abbas E. Kitabchi, PhD, MD

Arch Intern Med. 1997;157(6):669-675.

Abstract
Background
The hospital admission and mortality rates of patients with diabetic emergencies, such as diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNS), are higher in black patients than in white patients with diabetes. However, there is limited data describing the precipitating events and response to treatment in black patients. Analysis of their clinical characteristics and response to medical therapy is needed to evaluate the impact of programs designed to reduce the development of these acute metabolic complications.

Methods
A prospective evaluation was conducted of 144 consecutive patients with DKA and 23 patients with HHNS admitted to a large inner-city hospital between July 1993 and October 1994.

Results
In patients previously diagnosed as having diabetes, poor compliance with insulin therapy was the major precipitating cause for DKA (49%) and HHNS (42%). Alcohol or cocaine abuse was a contributing factor for noncompliance and was present in 35% and 13% of patients with DKA and in 44% and 9% of patients with HHNS, respectively. Newly diagnosed diabetes accounted for 17% of patients with DKA and HHNS. Obesity (body mass index >28 kg/m² [the weight in kilograms divided by the square of the height in meters] ) was present in 29% of patients with DKA and in 17% with HHNS and was most common in patients with DKA who were newly diagnosed as having diabetes (56%). Patients were treated by residents, who used a low-dose insulin protocol with an algorithm for insulin adjustment in 88 of 144 patients with DKA and 14 of 23 patients with HHNS. Although there was no difference in mortality rates or time needed to correct hyperglycemia or ketoacidosis, the use of the protocol significantly reduced the risk of hypoglycemia (5%) compared with patients treated without a protocol (23%) (P<.01).

Conclusions
In urban black patients, poor compliance with insulin therapy was the main precipitating cause of acute metabolic decompensation, and substance abuse was a significant contributing factor for noncompliance. Obesity is common in black patients with DKA; it was present in more than half of those with newly diagnosed diabetes. Improved patient education and better access to medical care might reduce the development of these hyperglycemic emergencies.

Arch Intern Med. 1997;157:669-675.

Author Affiliations
From the Department of Medicine, Emory University School of Medicine, Atlanta, Ga (Drs Umpierrez, Navarrete, and Casals and Mr Kelly), and the Department of Medicine, University of Tennessee, Memphis (Dr Kitabchi).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

A 48-year-old man with uncontrolled diabetes
HU and ISAACSON
Cleveland Clinic Journal of Medicine 2009;76:413-416.
FULL TEXT  

Hyperglycemic Crises in Adult Patients With Diabetes
Kitabchi et al.
Diabetes Care 2009;32:1335-1343.
FULL TEXT  

Insulin Analogs Versus Human Insulin in the Treatment of Patients With Diabetic Ketoacidosis: A randomized controlled trial
Umpierrez et al.
Diabetes Care 2009;32:1164-1169.
ABSTRACT | FULL TEXT  

Acidosis, phosphofructokinase, and diabetic coma
Rosival et al.
Br J Anaesth 2009;102:279-280.
FULL TEXT  

Hyperglycemic Crisis in Adults: Pathophysiology, Presentation, Pitfalls, and Prevention
Fowler
Clin. Diabetes 2009;27:19-23.
FULL TEXT  

Thirty Years of Personal Experience in Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State
Kitabchi et al.
J. Clin. Endocrinol. Metab. 2008;93:1541-1552.
ABSTRACT | FULL TEXT  

Hyperglycemic Crises in Adult Patients With Diabetes: A Consensus Statement From the American Diabetes Association: Response to Rosival
Kitabchi et al.
Diabetes Care 2007;30:e76-e76.
FULL TEXT  

Diabetic and endocrine emergencies
Kearney and Dang
Postgrad. Med. J. 2007;83:79-86.
ABSTRACT | FULL TEXT  

Hyperglycemic Crises in Adult Patients With Diabetes: A consensus statement from the American Diabetes Association
Kitabchi et al.
Diabetes Care 2006;29:2739-2748.
FULL TEXT  

Ketosis-Prone Type 2 Diabetes: Time to revise the classification of diabetes
Umpierrez
Diabetes Care 2006;29:2755-2757.
FULL TEXT  

Declining death rates from hyperglycemic crisis among adults with diabetes, u.s., 1985-2002.
Wang et al.
Diabetes Care 2006;29:2018-2022.
ABSTRACT | FULL TEXT  

Narrative review: ketosis-prone type 2 diabetes mellitus.
Umpierrez et al.
ANN INTERN MED 2006;144:350-357.
ABSTRACT | FULL TEXT  

Diabetes in African Americans
Marshall
Postgrad. Med. J. 2005;81:734-740.
ABSTRACT | FULL TEXT  

Racial/Ethnic Disparities in Potentially Preventable Readmissions: The Case of Diabetes
Jiang et al.
AJPH 2005;95:1561-1567.
ABSTRACT | FULL TEXT  

Recent advances in the monitoring and management of diabetic ketoacidosis
Wallace and Matthews
QJM 2004;97:773-780.
ABSTRACT | FULL TEXT  

Diabetic Ketoacidosis in Type 1 and Type 2 Diabetes Mellitus: Clinical and Biochemical Differences
Newton and Raskin
Arch Intern Med 2004;164:1925-1931.
ABSTRACT | FULL TEXT  

Treatment of Diabetic Ketoacidosis With Subcutaneous Insulin Aspart
Umpierrez et al.
Diabetes Care 2004;27:1873-1878.
ABSTRACT | FULL TEXT  

Hyperglycaemic crises and lactic acidosis in diabetes mellitus
English and Williams
Postgrad. Med. J. 2004;80:253-261.
ABSTRACT | FULL TEXT  

Inpatient to Outpatient Transfer of Care in Urban Patients With Diabetes: Patterns and Determinants of Immediate Postdischarge Follow-up
Wheeler et al.
Arch Intern Med 2004;164:447-453.
ABSTRACT | FULL TEXT  

Management of Diabetes and Hyperglycemia in Hospitals
Clement et al.
Diabetes Care 2004;27:553-591.
FULL TEXT  

Ketosis-Prone Diabetes--A New Subgroup of Patients with Atypical Type 1 and Type 2 Diabetes?
Kitabchi
J. Clin. Endocrinol. Metab. 2003;88:5087-5089.
FULL TEXT  

Changes in Serum Leptin in Lean and Obese Subjects with Acute Hyperglycemic Crises
Kitabchi and Umpierrez
J. Clin. Endocrinol. Metab. 2003;88:2593-2596.
ABSTRACT | FULL TEXT  

Abnormalities in Glucose Regulation During Antipsychotic Treatment of Schizophrenia
Newcomer et al.
Arch Gen Psychiatry 2002;59:337-345.
ABSTRACT | FULL TEXT  

Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Syndrome
Umpierrez et al.
Diabetes Spectr. 2002;15:28-36.
ABSTRACT | FULL TEXT  

Hyperglycemic Crises in Patients With Diabetes Mellitus
American Diabetes Association
Diabetes Care 2001;24:1988-1996.
FULL TEXT  

Response to Kirkman and Juneja and Lorber
Kitabchi
Diabetes Care 2001;24:2010-2011.
FULL TEXT  

Idiopathic Type 1 Diabetes in Dallas, Texas: A 5-year experience
Piñero-Piloña et al.
Diabetes Care 2001;24:1014-1018.
ABSTRACT | FULL TEXT  

Hyperglycemic Crises in Patients With Diabetes Mellitus
American Diabetes Association
Clin. Diabetes 2001;19:82-90.
FULL TEXT  

Management of Hyperglycemic Crises in Patients With Diabetes
Kitabchi et al.
Diabetes Care 2001;24:131-153.
FULL TEXT  

Hyperglycemic Crises in Patients With Diabetes Mellitus
American Diabetes Association
Diabetes Care 2001;24:154-161.
FULL TEXT  

New Profiles of Diabetic Ketoacidosis: Type 1 vs Type 2 Diabetes and the Effect of Ethnicity
Balasubramanyam et al.
Arch Intern Med 1999;159:2317-2322.
ABSTRACT | FULL TEXT  

Diabetic Ketoacidosis Associated With Cocaine Use
Warner et al.
Arch Intern Med 1998;158:1799-1802.
ABSTRACT | FULL TEXT