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J Clin Med 2019 Feb 15;8(2). Epub 2019 Feb 15.

Department of Regenerative Medicine & Transplantation, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.

Type 1 diabetes mellitus (T1DM) is caused by the autoimmune targeting of pancreatic β-cells, and, in the advanced stage, severe hypoinsulinemia due to islet destruction. In patients with T1DM, continuous exogenous insulin therapy cannot be avoided. However, an insufficient dose of insulin easily induces extreme hyperglycemia or diabetic ketoacidosis, and intensive insulin therapy may cause hypoglycemic symptoms including hypoglycemic shock. Read More

Can J Diabetes 2018 Dec 26. Epub 2018 Dec 26.

Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Royal University Hospital, Saskatoon, Saskatchewan, Canada. Electronic address:

Objectives: Despite published clinical practice guidelines in pediatrics for the use of a standardized diabetic ketoacidosis (DKA) protocol, our centre lacked an accepted, evidence-informed protocol for pediatric DKA management. Our primary aim was to attain broad clinical uptake of a DKA order set. Secondary aims included improved standard-of-care DKA management principles regarding fluid, potassium and dextrose administration. Read More

J Diabetes Investig 2019 Feb 15. Epub 2019 Feb 15.

Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors, the newest class of oral antidiabetes drugs for type 2 diabetes, ameliorate hyperglycemia primarily by preventing the reabsorption of urinary glucose in the kidneys. Within less than 5 years, abundant evidence for favorable characteristics of SGLT2 inhibitors has accumulated. Of note, large-scale clinical trials have revealed that these drugs prevent cardiovascular events, at least in cohorts at high risk for such events, and that they slow the decline in renal function. Read More

Eur J Case Rep Intern Med 2018 25;5(5):000853. Epub 2018 May 25.

Alta Intensità Medica, Department of Internal Medicine, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy.

Diabetic ketoacidosis (DKA) can quite frequently present in association with acute pancreatitis (AP) caused by transient severe hypertriglyceridemia (HTG). Here we report the case of a patient presenting with DKA, severe HTG and AP who received urgent plasma exchange for HTG control, and who reached adequate serum triglyceride levels only after appropriate DKA management. The treatment of patients presenting with DKA and coexistent AP associated with severe HTG should focus first on appropriate DKA management. Read More

Eur J Case Rep Intern Med 2018 27;5(12):000969. Epub 2018 Dec 27.

Department of Internal Medicine, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.

Mauriac syndrome, first described in 1930, is typically diagnosed in young patients with poorly controlled type 1 diabetes mellitus and growth retardation, delayed puberty, Cushingoid features, hypercholesterolaemia and hepatomegaly. However, the sole presenting feature of Mauriac syndrome can be hepatic glycogenosis in both adults and children. The mainstay of treatment for hepatic glycogenosis is strict control of glucose levels, with an excellent prognosis with improved glycaemic control. Read More

Eur J Case Rep Intern Med 2018 24;5(10):000957. Epub 2018 Oct 24.

Family Medicine Consultant, Primary Health Care Corporation, Doha, Qatar.

We report the case of a patient with type 1 diabetes who developed acute severe diabetic ketoacidosis following ingestion of an energy supplement containing caffeine. Some 95% of the US adult population consume caffeine, and the general perception is that there are no negative consequences for health. The upper limit of safe consumption is less than 400 mg per day. Read More

Intern Med J 2019 Feb;49(2):256-259

Department of Internal Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.

Ketoacidosis is uncommon in non-diabetic women, but occurs in the postpartum period as a rare complication of continuing to breastfeed during periods of acute illness. We report a case of a lactating woman who presented with severe symptomatic ketoacidosis in the early postpartum period. We also review the pathophysiology and management of lactation ketoacidosis. Read More

Acta Med Port 2019 Feb 1;32(1):17-24. Epub 2019 Feb 1.

Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.

Introduction: The use of continuous subcutaneous insulin infusion therapy in type 1 diabetes mellitus has increased due to its benefits on glycemic control and on the lifestyle flexibility. The aim of this study was to assess the impact of continuous subcutaneous insulin infusion therapy on glycemic control, body mass index, total daily dose of insulin and complications associated with this therapy, during 20 years of experience in Centro Hospitalar e Universitário de Coimbra.

Material And Methods: This retrospective study included patients with type 1 diabetes mellitus who started continuous subcutaneous insulin infusion therapy up until 2005, followed at Centro Hospitalar e Universitário de Coimbra. Read More

Endocr Pract 2019 Jan;25(1):69-100

Abbreviations: A1C = hemoglobin A1C; AACE = American Association of Clinical Endocrinologists; ACCORD = Action to Control Cardiovascular Risk in Diabetes; ACCORD BP = Action to Control Cardiovascular Risk in Diabetes Blood Pressure; ACE = American College of Endocrinology; ACEI = angiotensin-converting enzyme inhibitor; AGI = alpha-glucosidase inhibitor; apo B = apolipoprotein B; ARB = angiotensin II receptor blocker; ASCVD = atherosclerotic cardiovascular disease; BAS = bile acid sequestrant; BMI = body mass index; BP = blood pressure; CCB = calcium channel blocker; CGM = continuous glucose monitoring; CHD = coronary heart disease; CKD = chronic kidney disease; DKA = diabetic ketoacidosis; DPP4 = dipeptidyl peptidase 4; eGFR = estimated glomerular filtration rate; EPA = eicosapentaenoic acid; ER = extended release; FDA = Food and Drug Administration; GLP1 = glucagon-like peptide 1; HDL-C = high-density-lipoprotein cholesterol; HeFH = heterozygous familial hypercholesterolemia; LDL-C = low-density-lipoprotein cholesterol; LDL-P = low-density-lipoprotein particle; Look AHEAD = Look Action for Health in Diabetes; NPH = neutral protamine Hagedorn; OSA = obstructive sleep apnea; PCSK9 = proprotein convertase subtilisin-kexin type 9 serine protease; RCT = randomized controlled trial; SU = sulfonylurea; SGLT2 = sodium-glucose cotransporter 2; SMBG = self-monitoring of blood glucose; T2D = type 2 diabetes; TZD = thiazolidinedione. Read More

Ann Intensive Care 2019 Feb 11;9(1):29. Epub 2019 Feb 11.

Department of Endocrinology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

Background: We assessed the association of intravenous insulin and glucose infusion with intensive care unit (ICU) and hospital mortality.

Methods: For this retrospective association study, we used data from all patients admitted to a medical-surgical ICU between January 2012 and September 2017. We excluded patients admitted < 24 h, patients with a diabetic ketoacidosis, patients with a therapy restriction upon ICU admission and readmissions. Read More

Paediatr Int Child Health 2019 Feb 11:1-3. Epub 2019 Feb 11.

a 4th Department of Pediatrics, School of Medicine, Faculty of Health Sciences , Aristotle University of Thessaloniki, Papageorgiou General Hospital , Thessaloniki , Greece.

Neuropathy, a complication of type 1 diabetes (T1D), is a heterogeneous group, and chronic polyneuropathy is the most common form in adults. Αn 8-year-old girl admitted with severe diabetic ketoacidosis was diagnosed with T1D. She was managed with intravenous fluids and insulin and was subsequently commenced on multiple daily subcutaneous injections of insulin. Read More

Pediatr Diabetes 2019 Feb 9. Epub 2019 Feb 9.

Division of Population Medicine, School of Medicine, Cardiff University, Cardiff.

Objective: To evaluate primary care presentations during the prodrome (12 months prior to onset-Type 1 diabetes, with or without DKA), to identify opportunities for earlier diagnosis.

Methods: This was a case-control study, linking 16 years of data from children (≤15 years) registered at diagnosis of Type 1 diabetes, and routinely collected primary care records in Wales (UK). Controls (without Type 1 diabetes) were matched on a 3:1 ratio. Read More

Ther Adv Endocrinol Metab 2019 30;10:2042018818822207. Epub 2019 Jan 30.

Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Maccabi Juvenile Diabetes Center, Raanana, Israel; Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.

Objective: We examined short and long-term outcomes of bariatric surgery in patients with obesity and type 1 diabetes mellitus (T1DM).

Methods: We reviewed the records of all adults insured by Maccabi Healthcare Services during 2010 -2015, with body mass index (BMI) ⩾30 kg/m2 and T1DM; and compared weight reduction and glucose control according to the performance of bariatric surgery. BMI and glycated hemoglobin (HbA1c) levels were extracted for baseline and every 6 months, for a mean 3. Read More

Diabetes Care 2019 Feb 6. Epub 2019 Feb 6.

Diabetes Centre for Children and Adolescents, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany.

Sodium glucose cotransporter (SGLT) inhibitors are new oral antidiabetic medications shown to effectively reduce glycated hemoglobin (A1C) and glycemic variability, blood pressure and body weight without intrinsic properties to cause hypoglycemia in people with type 1 diabetes. However, recent studies, particularly in individuals with type 1 diabetes, have demonstrated increases in the absolute risk of diabetic ketoacidosis (DKA). Some cases presented with near-normal blood glucose levels or mild hyperglycemia, complicating the recognition/diagnosis of DKA and potentially delaying treatment. Read More

Curr Drug Saf 2019 Feb 6. Epub 2019 Feb 6.

Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER-Raebareli), Lucknow (UP). India.

Background: Recently, Food and Drug Administration (FDA) has approved sodium/glucose co-transporter 2 (SGLT2) inhibitors for the treatment of diabetes mellitus. However, regarding adverse drug reactions (ADRs) of SGLT2 inhibitors in large group of population, very less information is available. Thus, we have tried to find out the risk profile of SGLT 2 inhibitors. Read More

Case Rep Endocrinol 2019 6;2019:8974619. Epub 2019 Jan 6.

Department of Endocrinology, Diabetes, Metabolic Diseases and Nutrition, Mohammed VI University Hospital, Marrakech, Morocco.

Diabetic ketoacidosis (DKA) is a life-threatening acute metabolic complication occurring in patients with diabetes, especially in patients with type 1 diabetes (T1D), due to an insulin deficiency. Moderate hypertriglyceridemia is commonly observed in DKA but severe hypertriglyceridemia with a triglyceride level exceeding 10g/L is very rarely reported. We report a case of a 14-year-old boy who had type 1 diabetes for 4 years treated with insulin therapy, also having adrenal insufficiency treated with hydrocortisone who presented with ketoacidosis and excruciating abdominal pain. Read More

Clin Med Insights Endocrinol Diabetes 2019 24;12:1179551418825159. Epub 2019 Jan 24.

Endocrine Division, Department of Pediatrics, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, Saudi Arabia.

Objective: To determine the glycemic control and cardio-metabolic complications of children and adolescents with type 1 diabetes mellitus (T1DM) attending a tertiary care diabetes clinic in Saudi Arabia.

Methods: We conducted a retrospective cross-sectional study of children and adolescents with T1DM attending King Abdulaziz Medical City-Jeddah from 2010 to 2013. We assessed their glycemic control and diabetes management. Read More

Can J Diabetes 2018 Nov 17. Epub 2018 Nov 17.

Department of Medicine, Queen's University, Kingston, Ontario, Canada. Electronic address:

Objective: To assess safety and efficacy compared to a historical cohort. Clinical practice guidelines recommend that patients with diabetic ketoacidosis (DKA) be treated with a standardized protocol. We created a multifaceted order set to promote best-practice management of DKA. Read More

Diabet Med 2019 Feb 2. Epub 2019 Feb 2.

King's College London School of Life Course Sciences, London, UK.

Aims: To develop a novel interactive budget impact model that assesses affordability of diabetes treatments in specific populations, and to test the model in a hypothetical scenario by estimating cost savings resulting from reduction in HbA from ≥69 mmol/mol (8.5%) to a target of 53 mmol/mol (7.0%) in adults with Type 1 diabetes in the UK. Read More

Nat Commun 2019 Feb 1;10(1):548. Epub 2019 Feb 1.

Departments of Internal Medicine, Yale University School of Medicine, P.O. Box 208020, TAC S269, New Haven, CT, 06519, USA.

Sodium-glucose transport protein 2 (SGLT2) inhibitors are a class of anti-diabetic agents; however, concerns have been raised about their potential to induce euglycemic ketoacidosis and to increase both glucose production and glucagon secretion. The mechanisms behind these alterations are unknown. Here we show that the SGLT2 inhibitor (SGLT2i) dapagliflozin promotes ketoacidosis in both healthy and type 2 diabetic rats in the setting of insulinopenia through increased plasma catecholamine and corticosterone concentrations secondary to volume depletion. Read More

Biomed J 2018 Dec 11;41(6):348-355. Epub 2019 Jan 11.

Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address:

Background: This study compared event rates of diabetic ketoacidosis (DKA) and severe hypoglycemia, as well as glycemic control, among children, adolescents, and young adults with type 1 diabetes mellitus (T1DM) receiving basal-bolus or premixed insulin therapy.

Methods: A total of 825 individuals aged ≤ 20 years with T1DM, using either basal-bolus or premixed insulin regimens, were retrospectively recruited from 2001 to 2015. Rates of DKA after diagnosis, severe hypoglycemia, and the level of glycated hemoglobin A1c (HbA1c) improvement during the follow-up period were analyzed. Read More

Diabetes Ther 2019 Jan 31. Epub 2019 Jan 31.

Dr Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India.

The current diabetes management strategies not only aim at controlling glycaemic parameters but also necessitate continuous medical care along with multifactorial risk reduction through a comprehensive management concept. The sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a group of evolving antidiabetic agents that have the potential to play a pivotal role in the comprehensive management of patients with diabetes due to their diverse beneficial effects. SGLT2i provide moderate glycaemic control, considerable body weight and blood pressure reduction, and thus have the ability to lower the risk of macrovascular and microvascular complications. Read More

J Pediatr Endocrinol Metab 2019 Feb;32(2):115-119

Saudi Board Family Medicine, Ministry of Health, Qassim, Saudi Arabia.

Background As per the International Society for Pediatrics and Adolescent Diabetes (ISPAD) census, diabetic ketoacidosis (DKA) is the most frequent cause of diabetes-related death. In developing countries, DKA-related mortality rate ranges from 6% to 24% (Onyiriuka AN, Ifebi E. Ketoacidosis at diagnosis of type 1 diabetes in children and adolescents: frequency and clinical characteristics. Read More

Am J Health Syst Pharm 2019 Feb;76(5):301-311

Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL.

Purpose: The purpose of this study was to develop a dynamic risk prediction model for inpatient hypokalemia and evaluate its predictive performance.

Methods: A retrospective cohort included all admissions aged 18 years and above from 2 large tertiary hospitals in Florida over a 22-month period. Hypokalemia was defined as a potassium value of less than 3 mmol/L, and subsequent initiation of potassium supplements. Read More

World J Diabetes 2019 Jan;10(1):57-62

Department of Medicine, Texas A and M University, Corpus Christi, TX 78404, United States.

Background: Diabetic ketoacidosis (DKA) has an associated mortality of 1% to 5%. Upon admission, patients require insulin infusion and close monitoring of electrolyte and blood sugar levels with subsequent transitioning to subcutaneous insulin and oral nutrition. No recommendations exist regarding the appropriate timing for initiation of oral nutrition. Read More

World J Diabetes 2019 Jan;10(1):16-22

Division of Pulmonary, Critical Care and Sleep Medicine, Texas A and M University, Corpus Christy, TX 78412, United States.

Diabetes affects approximately 30 million persons in the United States. Diabetes ketoacidosis is one of the most serious and acute complications of diabetes. At the time of presentation and during treatment of diabetic ketoacidosis (DKA), several metabolic and electrolyte derangements can ultimately result in respiratory compromise. Read More

Front Endocrinol (Lausanne) 2018 15;9:812. Epub 2019 Jan 15.

Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States.

In patients with type 2 diabetes, bariatric surgery can lead to significant improvements in glycemic control and diabetes remission. We present a case of a Hispanic female with type 2 diabetes phenotype who underwent bariatric surgery and post-operatively stopped her insulin therapy due to multiple reasons, including decreased oral intake and concern for hypoglycemia. Ultimately, she developed diabetic ketoacidosis. Read More

BMJ Case Rep 2019 Jan 28;12(1). Epub 2019 Jan 28.

Department of Biomedical Sciences, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA.

A 21-year-old young man with no history of diabetes or thyroid disease presented to the emergency department with simultaneous thyroid storm and diabetic ketoacidosis. Notable findings on admission were a ventricular rate of 235 beats/min, tachypnoea, tremors, polydipsia and a lack of fever. Due to the unusual constellation of symptoms, diagnosis was only possible after initial laboratory results came back. Read More

Cureus 2018 Nov 19;10(11):e3608. Epub 2018 Nov 19.

Internal Medicine, Louis Stokes Cleveland VA Medical Center/Case Western Reserve University School of Medicine, Cleveland, USA.

Epidermolysis bullosa acquisita is a rare autoimmune bullous disease involving the skin and mucosa, most commonly treated with systemic corticosteroids. This case illustrates the importance of counseling patients on medication side effects and ensuring close physician follow-up during an extended course of steroids. A 46-year-old man presented to the emergency department with weakness, fatigue, dizziness and polyuria in the setting of eight weeks of prednisone therapy for a flare-up of his bullous disease. Read More

Ann Palliat Med 2019 Jan 17. Epub 2019 Jan 17.

Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK.

Death is an inevitable part of living. There are undoubtedly clinical and psychological challenges when any individual is passing from life to death. For a person with a long-term condition such as diabetes, these challenges can be compounded and impact on the care and experience of both the individual and their families and carers. Read More

Diabetes Res Clin Pract 2019 Jan 24. Epub 2019 Jan 24.

Division of Endocrinology, Institute of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates.

Context: There has been an increased interest in the potential metabolic derangements and acute complications of diabetes related to the Muslims' fasting during the month of Ramadan.

Objectives: We compared the incidence of admissions due to diabetic ketoacidosis (DKA) during Ramadan with the admissions during other months.

Methods: This is a retrospective electronic database and chart review study that included all Muslims who were admitted with DKA to Sheikh Khalifa Medical City in Abu Dhabi, United Arab Emirates. Read More

Am J Forensic Med Pathol 2019 Jan 23. Epub 2019 Jan 23.

Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.

Acute esophageal necrosis (AEN), also known as black esophagus, is a rare clinical entity. It is recently described to be associated with diabetic ketoacidosis (DKA) in a few case reports. Wischnewsky lesions (WLs) are a classic postmortem finding seen in fatal hypothermia but are recently described to be associated with DKA. Read More

Cardiovasc Drugs Ther 2019 Jan 24. Epub 2019 Jan 24.

Atherothrombosis Research Unit, Icahn School of Medicine at Mount Sinai Hospital, New York City, NY, USA.

The SGLT2 inhibitor empagliflozin reduced cardiovascular mortality by 38% and heart failure (HF) hospitalizations by 35% in diabetic patients. We have recently demonstrated the efficacy of empagliflozin in ameliorating HF and improving cardiac function in a non-diabetic porcine model of HF mediated via a switch in myocardial metabolism that enhances cardiac energetics. Therefore, we hypothesized that the cardiac benefits of empagliflozin can also be extended to non-diabetic HF patients. Read More

Front Pharmacol 2018 8;9:1517. Epub 2019 Jan 8.

Department of Bone and Joint Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

The effect of anti-diabetic medications on bone metabolism has received increasing attention, considering that type 2 diabetes mellitus is a common metabolic disorder with adverse effects on bone metabolism. Sodium-glucose co-transporter 2 (SGLT2) inhibitors are novel anti-diabetic medications that prevent glucose resorption at the proximal convoluted tubules in the kidney, increasing urinary glucose excretion, and decreasing the blood glucose level. The superiority of SGLT2 inhibitors shows in reducing the glucose level independent of insulin secretion, lowering the risk of hypoglycemia, and improving cardiovascular outcomes. Read More

Diabetes Care 2019 Feb;42(2):e24

Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA.

J Diabetes Investig 2019 Jan 18. Epub 2019 Jan 18.

Center for Diabetes and Endocrinology, The Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka, Japan.

A patient with mitochondrial diabetes mellitus developed diabetic ketoacidosis. During insulin treatment, although diabetic ketoacidosis improved, lactic acidosis unexpectedly worsened. This clinical course, named "switched metabolic acidosis," could reflect the unique pathophysiology of the mitochondrial disorder. Read More

Endocr Pract 2019 Jan 18. Epub 2019 Jan 18.

Division of Endocrinology and Metabolism, University of Pittsburgh Medical Center.

Objective To determine the efficacy and safety of a DKA-Power Plan(PP) for guiding IV insulin infusions prior to anion gap (AG) closure and administering subcutaneous (SC) insulin ≥1 hour before discontinuing IV insulin. Methods Retrospective chart review of patients with DKA before (Pre-PP) (n = 60) and following (Post-PP) (n = 60) implementation of a DKA-PP. Groups were compared for percentage of patients for whom IV insulin therapy was continued until AG closure, the percentage of patients receiving SC insulin ≥1hr before discontinuation of IV insulin, and percentage of patients with rebound DKA during the index hospitalization. Read More

Diabetes Technol Ther 2019 Feb 18;21(2):66-72. Epub 2019 Jan 18.

8 Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, Colorado.

Objective: To provide a snapshot of the profile of adults and youth with type 1 diabetes (T1D) in the United States and assessment of longitudinal changes in T1D management and clinical outcomes in the T1D Exchange registry.

Research Design And Methods: Data on diabetes management and outcomes from 22,697 registry participants (age 1-93 years) were collected between 2016 and 2018 and compared with data collected in 2010-2012 for 25,529 registry participants.

Results: Mean HbA1c in 2016-2018 increased from 65 mmol/mol at the age of 5 years to 78 mmol/mol between ages 15 and 18, with a decrease to 64 mmol/mol by age 28 and 58-63 mmol/mol beyond age 30. Read More

Diabetes Care 2019 Jan 17. Epub 2019 Jan 17.

Diabetes Center Karlsburg, Karlsburg, Germany.

Medicine (Baltimore) 2019 Jan;98(3):e14150

Department of Internal Medicine, Keimyung University School of Medicine.

Rationale: Dapagliflozin (a sodium-glucose cotransporter-2 [SGLT2] inhibitor) represents the most recently approved class of oral medications for the treatment of type 2 diabetes. Dapagliflozin lowers plasma glucose concentration by inhibiting the renal reuptake of glucose in the proximal renal tubules. In 2015, the US Food and Drug Administration released a warning concerning a potential increased risk of ketoacidosis in patients taking this medication. Read More

Acute Med Surg 2019 Jan 24;6(1):78-82. Epub 2018 Oct 24.

Department of Traumatology and Critical Care Medicine National Defense Medical College Saitama Japan.

Case: We describe a rare case of antibiotic-associated fulminant pseudomembranous enterocolitis caused by . A 79-year-old man with a history of antibiotic therapy was admitted to our emergency department, complaining of consciousness disturbance. Initially, we suspected septic shock and diabetic ketoacidosis caused by intestinal infection. Read More

Case Rep Endocrinol 2018 17;2018:4328954. Epub 2018 Dec 17.

Advocate Lutheran General Hospital, Park Ridge, IL, USA.

Isoproterenol is known to cause insulin resistance and is often used to treat bradyarrhythmias from atrioventricular block. We report a case of isoproterenol induced diabetic ketoacidosis in a 77-year-old female patient treated with isoproterenol for atrioventricular block prior to insertion of permanent pacemaker. Diabetic ketoacidosis (DKA) developed within hours of starting an isoproterenol drip, and there were no other precipitating factors at that time. Read More

Arch Pediatr 2019 Feb 12;26(2):95-101. Epub 2019 Jan 12.

Unité endocrinologie et diabétologie pédiatrique, université Bordeaux, CHU Bordeaux, 33000 Bordeaux, France. Electronic address:

Background: The impact of 7-day real-time continuous glucose monitoring (RT-CGM) on type 1 diabetes (T1D) management remains unknown in youths with suboptimal control by multiple daily injections (MDI). The DIACCOR Study aimed to describe treatment decisions and glucose outcomes after a short-term RT-CGM sequence in real-life conditions.

Methods: This French multicenter longitudinal observational study included T1D youths with HbA1c>7. Read More

Diabetes Metab Syndr 2019 Jan - Feb;13(1):216-221. Epub 2018 Aug 22.

Department of Internal Medicine, Division of Endocrinology, Saint Louis University School of Medicine, United States. Electronic address:

Aims: Although diabetic ketoacidosis (DKA) commonly presents as a pure diabetic ketoacidosis (PDKA), up to 30% of cases may be associated with a mixed hypochloremic metabolic alkalosis (HMA). It is unknown whether there is a difference in treatment outcomes between these two entities. We evaluated an insulin infusion protocol (IIP), previously validated for hyperglycemia management in ICU's, for the management of PDKA and HMA. Read More

J Crit Care 2019 Apr 25;50:257-261. Epub 2018 Dec 25.

Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada.

Purpose: There is wide variation in the utilization of Intensive Care Unit (ICU) beds for treatment and monitoring of adult patients with Diabetic Ketoacidosis (DKA). We sought to compare the outcomes and hospital costs of adult DKA patients admitted to ICUs as compared to those admitted to step-down units.

Materials And Methods: We included consecutive adult patients from two hospitals with a diagnosis of DKA. Read More

Eur J Pharmacol 2019 Mar 11;846:23-29. Epub 2019 Jan 11.

Center for Pharmacy and Experimental Therapeutics, University of Georgia College of Pharmacy, Augusta, GA, USA; Charlie Norwood VA Medical Center, Augusta, Georgia, USA; Vascular Biology Center, Department of Pharmacology and Toxicology, Augusta University, Augusta, GA, USA; Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA. Electronic address:

The prevalence of type 2 diabetes mellitus (T2D) has risen in the United States and worldwide, with an increase in global prevalence from 4.7% to 8.5% between 1980 and 2014. Read More

Diabetes Metab 2019 Jan 9. Epub 2019 Jan 9.

Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea. Electronic address:

Aim: This study investigated the clinical characteristics of diabetic ketoacidosis (DKA) and compared the DKA characteristics between patients treated with and without SGLT2 inhibitors.

Methods: Data were collected from patients aged ≥ 18 years admitted for DKA at nine centres in Korea between September 2014 and April 2017. The electronic medical records of these subjects were retrospectively reviewed. Read More

Emerg Med J 2019 Jan;36(1):51-60

Department of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.

Clinical Introduction: A 56-year-old man without known medical history was brought to our ED after he was found next to his bed, agitated and with waxing and waning consciousness. He has been bedbound for 5 days after a long-standing period of malnutrition. Physical examination reveals Kussmaul breathing, heart rate of 62/min and blood pressure of 135/100 mm Hg, normal cardiac, abdominal and a non-focal neurological examination other than confusion and altered level of consciousness. Read More

J Ayub Med Coll Abbottabad 2018 Oct-Dec;30(4):596-602

Department of Medicine Khyber Teaching Hospital Peshawar, Pakistan.

Ramadan, the ninth month of Islamic calendar brings alongwith it a sense of responsibility to fast among the Muslim adult population. Though patients with chronic illnesses like Diabetes mellitus are exempted from fasting during the month if their health does not allow, they still wish to fast. This creates a challenge for the health care professionals to enable the patients with Diabetes mellitus to fast safely, without developing complications like hypoglycemia, hyperglycemia, ketoacidosis and thrombosis. Read More