A study to assess the clinicopathological spectrum of acute complications of diabetes mellitus type II

Kunal Lala, Viren Bhati, Divya Lala, Smita Patil


Background: The acute metabolic complications of diabetes consist of diabetic ketoacidosis (DKA), hyperosmolar non-ketotic coma (HNC), lactic acidosis (LA), and hypoglycemia. All of these are associated with significant morbidity and mortality. These can easily be prevented by early recognition and prompt management. Therefore, this study was conducted to assess the clinicopathological spectrum of acute complications of diabetes mellitus type II.

Methods: This observational, analytical study was conducted on 100 patients aged more than 18 years admitted in the ICU with acute complication of Diabetes mellitus Type II. Medical history was recorded. Physical examination and investigations were done and recorded.

Results: The mean age of the study population was 55.26±13.13 years. Hypoglycemia was more common (63%) than DKA (37%). Fever and sweating had the overall highest incidence (and were more in patients with hypoglycemia) while stupor, nausea and abdominal pain had the lowest incidence (and were more in patients with DKA). On examination, only one patient of DKA was drowsy. Mean temperature, pulse and respiratory rate were higher in the patients having DKA while blood pressure was higher in patients having hypoglycemia.

Conclusions: It can be effectively concluded from the present study that DKA and hypoglycaemia have a broad spectrum of clinicopathological features. But the incidences vary widely. This may help in early recognition of the impending complication and thereby enabling prompt management of the same, reducing the associated morbidity and mortality. 



Diabetes mellitus type II, Diabetic ketoacidosis, Hypoglycemia, Hyperosmolar non-ketotic coma, Lactic acidosis

Full Text:



Adeyinka A, Kondamudi NP. Hyperosmolar hyperglycemic nonketotic coma (HHNC, hypero-smolar hyperglycemic nonketotic syndrome). In: StatPearls. Treasure Island (FL): StatPearls Publishing; Available at: https://www.ncbi. Accessed on 25th May 2020.

Arleta Rewers Ed. Acute metabolic complications in diabetes. Chapter 17. In: Diabetes In America, 3rd Edi. London: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health; 2018.

Farsani SF, Brodovicz K, Soleymanlou N, Marquard J, Wissinger E, Maiese BA. Incidence and prevalence of diabetic ketoacidosis (DKA) among adults with type 1 diabetes mellitus (T1D): a systematic literature review. BMJ Open. 2017;7(7):e016587.

Fazeli Farsani S, Brodovicz K, Soleymanlou N, Marquard J, Wissinger E, et al. Incidence and prevalence of diabetic ketoacidosis (DKA) among adults with type 1 diabetes mellitus (T1D): a systematic literature review. BMJ Open. 2017;7(7):e016587.

Wolfsdorf JI, Allgrove J, Craig ME, Edge J, Glaser N, Jain V, et al. International Society for Pediatric and Adolescent Diabetes: ISPAD Clinical Practice Consensus Guidelines 2014. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2014;15(Suppl 20):154-79.

Dabelea D, Rewers A, Stafford JM, Standiford DA, Lawrence JM, Saydah S, et al. Search for diabetes in youth study group: trends in the prevalence of ketoacidosis at diabetes diagnosis: the search for diabetes in Youth study. Pediatr. 2014;133:e938-45.

Kitabchi AE, Umpierrez GE, Murphy MB, Kreisberg RA. Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American diabetes association. Diabetes Care. 2006;29:2739-48.

Shah BR, Hux JE. Quantifying the risk of infectious diseases for people with diabetes. Diabetes Care. 2003;26(2):510-3.

Gillan Booth, Jiming Fang. Acute Complications of Diabetes: In Hux JE, Booth GL, Slaughter PM, Laupacis A (eds). Diabetes in Ontario: an ICES practice atlas: Institute for clinical evaluative sciences. 2003:220-31.

Eledrisi MS, Alshanti MS, Shah MF, Brolosy B, Jaha N. Overview of the diagnosis and management of diabetic ketoacidosis. Am J Med Sci. 2006;331:243-51.

Adhikari PM, Mohammed N, Pereira P. Changing profile of diabetic ketosis. J Indian Med Assoc. 1997;95(10):540-2.

Faich GA, Fishbein HA, Ellis SE. The epidemiology of diabetic acidosis: a population based study. Am J Epidemiol. 1983;117:551-8.

Kreisberg R. Diabetic ketoacidosis. In: Rifkin H, Porte D (eds). Diabetes mellitus: Theory and practice. 4th edn. New York: Elsevier Science; 1990:591-603.

Beigelman PM. Severe diabetic ketoacidosis (diabetic “coma”). 482 episodes in 257 patients; experience of three years. Diabet. 1971;20:490-500.

Mahesh MG, Shivaswamy RP, Chandra BS, Syed S. The study of different clinical pattern of diabetic ketoacidosis and common precipitating events and independent mortality factors. J Clin Diagn Res. 2017;11(4):OC42-OC46.

Munro JF, Campbell IW, Mc Cuish AC, Duncan LJ. Euglycaemic diabetic ketoacidosis. Br Med J. 1973;2:578-80.

Umpierrez G, Freire AX. Abdominal pain in patients with hyperglycaemic crises. J Crit Care. 2002;17:63-7.

Kanwal SK, Bando A, Kumar V. Clinical profile of diabetic ketoacidosis in Indian children. Indian J Pediatr. 2012;79:901-4.

Seth P, Kaur H, Kaur M. Clinical profile of diabetic ketoacidosis: a prospective study in a tertiary care hospital. J Clin Diagn Res. 2015;9(6):OC01-4.

Mbugua P, Otieno C, Kayima J, Amayo A, Mcligeyo S. Diabetic ketoacidosis: clinical presentation and precipitating factors at Kenyatta National Hospital, Nairobi. East African Med J. 2005;82:S191-6.

Ramesh HG, Krishnappa PP, Prasad D, Farahat S, Ranganath TS. Acute metabolic complications of diabetes mellitus in a tertiary care center Int J Adv Med. 2017;4(4):985-8.

Richy FF, Sabidó-Espin M, Guedes S, Corvino FA, Gottwald-Hostalek U. Incidence of lactic acidosis in patients with type 2 diabetes with and without renal impairment treated with metformin: a retrospective cohort study. Diabetes Care. 2014;37(8):2291-5.

Westphal SA. The occurrence of diabetic ketoacidosis in non-insulin dependent diabetes and newly diagnosed diabetic adults. Am J Med. 1996;101(1):19-24.

Matoo VK, Nalini K, Dash RJ. Clinical profile and treatment outcome of diabetic ketoacidosis. J Assoc Physicians India. 1991;39:379-81.

Chiasson JL, Jilwan NA, Belanger R, et al. Diagnosis and treatment of diabetic ketoacidosis and the hyperglycaemic hyperosmolar state. CMAJ. 2003;168(7):859-66.

Barski L, Nevzorov R, Harman-Boehm I, Jotkowitz A, Rabaev E, Zektser M, et al. Comparison of diabetic ketoacidosis in patients with type-1 and type-2 diabetes mellitus. Am J Med Sci. 2013;345(4):326-30.

Basavanthappa SP, Pejaver R, Raghavendra K, Srinivasa V, Suresh Babu MT. Clinical profile and outcome of diabetic ketoacidosis in a tertiary care hospital in South India. Int J Contemp Pediatr. 2015;2(1):29-3.