Characteristics of diabetic ketoacidosis in older versus younger adults

M. L. Malone, V. Gennis, James Goodwin

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Abstract

Objective: To describe how diabetic ketoacidosis in those aged 65 or over differs from that in younger adults. Design: Retrospective chart review of all adult patients with a primary or secondary discharge diagnosis of diabetic ketoacidosis (n = 338). Setting: Three urban teaching hospitals in Milwaukee, WI from January 1, 1987 to May 31, 1990. Patients: Two hundred twenty cases in 150 patients met our criteria for severity of illness to be included in the study. Twenty-seven cases were in patients ≥ age 65; 193 cases were in patients < age 65. Results: The older patients were less likely to have been using insulin before hospitalization (55.6% vs 80.2%, P = 0.004) and less likely to have had a prior episode of diabetic ketoacidosis (8.0% vs 51.4%, P = 0.001). The presenting laboratory data were not significantly different between older and younger subjects. There was a trend toward a higher mean insulin dosage to bring the patient's blood glucose to ≤300 mg/dL for those age 65 or older; 69.1 units vs 44.9 units (P = 0.06). The time required to obtain a glucose <300 mg/dL was greater in older patients (10.5 vs 7.7 hours, P = 0.01). The average length of stay for those age 65 or older was 12.4 days vs 6.7 days (P = 0.001). Thirdly, of those age 65 or older, 7% vs 29% of younger subjects had a blood glucose or Accucheck ≤ 49 mg/dL at some time during their hospital course. The hypoglycemic episodes were more likely to be asymptomatic in older patients (P = 0.03). The mortality rate was 22% for those age 65 or older vs 2% for younger subjects (P = 0.001). The mortality rate for those in age groups 60-69 years, 70-79 years, and ≥ 80 years was 8%, 27%, and 33%, respectively. In patients ≥ 65, mortality was confined to those with coexisting renal disease or infection. Conclusion: Older patients with diabetic ketoacidosis are less likely to have been using insulin before hospitalization. They tend to receive more insulin therapy during their acute management, have a longer average length of hospital stay, and have a higher mortality rate.

Original languageEnglish (US)
Pages (from-to)1100-1104
Number of pages5
JournalJournal of the American Geriatrics Society
Volume40
Issue number11
StatePublished - 1992
Externally publishedYes

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Diabetic Ketoacidosis
Young Adult
Insulin
Length of Stay
Mortality
Blood Glucose
Hospitalization
Urban Hospitals
Hypoglycemic Agents
Teaching Hospitals
Age Groups

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Characteristics of diabetic ketoacidosis in older versus younger adults. / Malone, M. L.; Gennis, V.; Goodwin, James.

In: Journal of the American Geriatrics Society, Vol. 40, No. 11, 1992, p. 1100-1104.

Research output: Contribution to journalArticle

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abstract = "Objective: To describe how diabetic ketoacidosis in those aged 65 or over differs from that in younger adults. Design: Retrospective chart review of all adult patients with a primary or secondary discharge diagnosis of diabetic ketoacidosis (n = 338). Setting: Three urban teaching hospitals in Milwaukee, WI from January 1, 1987 to May 31, 1990. Patients: Two hundred twenty cases in 150 patients met our criteria for severity of illness to be included in the study. Twenty-seven cases were in patients ≥ age 65; 193 cases were in patients < age 65. Results: The older patients were less likely to have been using insulin before hospitalization (55.6{\%} vs 80.2{\%}, P = 0.004) and less likely to have had a prior episode of diabetic ketoacidosis (8.0{\%} vs 51.4{\%}, P = 0.001). The presenting laboratory data were not significantly different between older and younger subjects. There was a trend toward a higher mean insulin dosage to bring the patient's blood glucose to ≤300 mg/dL for those age 65 or older; 69.1 units vs 44.9 units (P = 0.06). The time required to obtain a glucose <300 mg/dL was greater in older patients (10.5 vs 7.7 hours, P = 0.01). The average length of stay for those age 65 or older was 12.4 days vs 6.7 days (P = 0.001). Thirdly, of those age 65 or older, 7{\%} vs 29{\%} of younger subjects had a blood glucose or Accucheck ≤ 49 mg/dL at some time during their hospital course. The hypoglycemic episodes were more likely to be asymptomatic in older patients (P = 0.03). The mortality rate was 22{\%} for those age 65 or older vs 2{\%} for younger subjects (P = 0.001). The mortality rate for those in age groups 60-69 years, 70-79 years, and ≥ 80 years was 8{\%}, 27{\%}, and 33{\%}, respectively. In patients ≥ 65, mortality was confined to those with coexisting renal disease or infection. Conclusion: Older patients with diabetic ketoacidosis are less likely to have been using insulin before hospitalization. They tend to receive more insulin therapy during their acute management, have a longer average length of hospital stay, and have a higher mortality rate.",
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