Hyperosmolar hyperglycemic state risk factors

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Common risk factors in the development of hyperosmolar hyperglycemic state (HHS) are old age, high mean glycosylated hemoglobin A1c, acute stresses like infections, myocardial infarction, pancreatitis, poor diabetes control, noncompliance with insulin, poor cardiac and renal functions and low socioeconomic status.

Risk Factors

Factors increasing risk

The following factors are associated with an increased risk of hyperosmolar hyperglycemic state (HHS):^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]

Old age
Obesity
High mean glycosylated hemoglobin A1c (HbA1c)
Infection
Physiological stressors:
Hypothermia
Dialysis
Burns
Neuroleptic malignant syndrome
Rhabdomyolysis
Depression
Lack of health insurance
Low body mass index (BMI)
Delayed or improper management of diabetes

Factors decreasing risk

The following factors are associated with a reduced risk of hyperosmolar hyperglycemic state (HHS):^[12]

Optimum management of diabetes
Optimum fluid intake
Adequate renal functions
Adequate cardiac functions
Higher education level of patient
Higher education level of care giver

References

↑ Weinstock RS, Xing D, Maahs DM, Michels A, Rickels MR, Peters AL, Bergenstal RM, Harris B, Dubose SN, Miller KM, Beck RW (2013). "Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D Exchange clinic registry". J. Clin. Endocrinol. Metab. 98 (8): 3411–9. doi:10.1210/jc.2013-1589. PMID 23760624.
↑ "Clinical and socio-demographic factors associated with diabetic ketoacidosis hospitalization in adults with Type 1 diabetes - Butalia - 2013 - Diabetic Medicine - Wiley Online Library".
↑ Cengiz E, Xing D, Wong JC, Wolfsdorf JI, Haymond MW, Rewers A, Shanmugham S, Tamborlane WV, Willi SM, Seiple DL, Miller KM, DuBose SN, Beck RW (2013). "Severe hypoglycemia and diabetic ketoacidosis among youth with type 1 diabetes in the T1D Exchange clinic registry". Pediatr Diabetes. 14 (6): 447–54. doi:10.1111/pedi.12030. PMC 4100244. PMID 23469984.
↑ "Diabetes Care".
↑ Low JC, Felner EI, Muir AB, Brown M, Dorcelet M, Peng L, Umpierrez GE (2012). "Do obese children with diabetic ketoacidosis have type 1 or type 2 diabetes?". Prim Care Diabetes. 6 (1): 61–5. doi:10.1016/j.pcd.2011.11.001. PMC 3746511. PMID 22230097.
↑ Katz JR, Edwards R, Khan M, Conway GS (1996). "Acromegaly presenting with diabetic ketoacidosis". Postgrad Med J. 72 (853): 682–3. PMC 2398638. PMID 8944212.
↑ Burzynski J (2005). "DKA and thrombosis". CMAJ. 173 (2): 132, author reply 132–3. doi:10.1503/cmaj.1050103. PMC 1174837. PMID 16027420.
↑ Jovanovic A, Stolic RV, Rasic DV, Markovic-Jovanovic SR, Peric VM (2014). "Stroke and diabetic ketoacidosis--some diagnostic and therapeutic considerations". Vasc Health Risk Manag. 10: 201–4. doi:10.2147/VHRM.S59593. PMC 3986295. PMID 24748799.
↑ Pivonello R, De Leo M, Vitale P, Cozzolino A, Simeoli C, De Martino MC, Lombardi G, Colao A (2010). "Pathophysiology of diabetes mellitus in Cushing's syndrome". Neuroendocrinology. 92 Suppl 1: 77–81. doi:10.1159/000314319. PMID 20829623.
↑ Pasternak DP (1974). "Hemochromatosis presenting as diabetic ketoacidosis with extreme hyperglycemia". West. J. Med. 120 (3): 244–6. PMC 1129403. PMID 4205898.
↑ Kamalakannan D, Baskar V, Barton DM, Abdu TA (2003). "Diabetic ketoacidosis in pregnancy". Postgrad Med J. 79 (934): 454–7. PMC 1742779. PMID 12954957.
↑ "Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review | The BMJ".

Template:WH Template:WS

[pmid23760624-1] Weinstock RS, Xing D, Maahs DM, Michels A, Rickels MR, Peters AL, Bergenstal RM, Harris B, Dubose SN, Miller KM, Beck RW (2013). "Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D Exchange clinic registry". J. Clin. Endocrinol. Metab. 98 (8): 3411–9. doi:10.1210/jc.2013-1589. PMID 23760624.

[urlClinical_and_socio-demographic_factors_associated_with_diabetic_ketoacidosis_hospitalization_in_adults_with_Type_1_diabetes_-_Butalia_-_2013_-_Diabetic_Medicine_-_Wiley_Online_Library-2] "Clinical and socio-demographic factors associated with diabetic ketoacidosis hospitalization in adults with Type 1 diabetes - Butalia - 2013 - Diabetic Medicine - Wiley Online Library".

[pmid23469984-3] Cengiz E, Xing D, Wong JC, Wolfsdorf JI, Haymond MW, Rewers A, Shanmugham S, Tamborlane WV, Willi SM, Seiple DL, Miller KM, DuBose SN, Beck RW (2013). "Severe hypoglycemia and diabetic ketoacidosis among youth with type 1 diabetes in the T1D Exchange clinic registry". Pediatr Diabetes. 14 (6): 447–54. doi:10.1111/pedi.12030. PMC 4100244. PMID 23469984.

[urlDiabetes_Care-4] "Diabetes Care".

[pmid22230097-5] Low JC, Felner EI, Muir AB, Brown M, Dorcelet M, Peng L, Umpierrez GE (2012). "Do obese children with diabetic ketoacidosis have type 1 or type 2 diabetes?". Prim Care Diabetes. 6 (1): 61–5. doi:10.1016/j.pcd.2011.11.001. PMC 3746511. PMID 22230097.

[pmid8944212-6] Katz JR, Edwards R, Khan M, Conway GS (1996). "Acromegaly presenting with diabetic ketoacidosis". Postgrad Med J. 72 (853): 682–3. PMC 2398638. PMID 8944212.

[pmid16027420-7] Burzynski J (2005). "DKA and thrombosis". CMAJ. 173 (2): 132, author reply 132–3. doi:10.1503/cmaj.1050103. PMC 1174837. PMID 16027420.

[pmid24748799-8] Jovanovic A, Stolic RV, Rasic DV, Markovic-Jovanovic SR, Peric VM (2014). "Stroke and diabetic ketoacidosis--some diagnostic and therapeutic considerations". Vasc Health Risk Manag. 10: 201–4. doi:10.2147/VHRM.S59593. PMC 3986295. PMID 24748799.

[pmid20829623-9] Pivonello R, De Leo M, Vitale P, Cozzolino A, Simeoli C, De Martino MC, Lombardi G, Colao A (2010). "Pathophysiology of diabetes mellitus in Cushing's syndrome". Neuroendocrinology. 92 Suppl 1: 77–81. doi:10.1159/000314319. PMID 20829623.

[pmid4205898-10] Pasternak DP (1974). "Hemochromatosis presenting as diabetic ketoacidosis with extreme hyperglycemia". West. J. Med. 120 (3): 244–6. PMC 1129403. PMID 4205898.

[pmid12954957-11] Kamalakannan D, Baskar V, Barton DM, Abdu TA (2003). "Diabetic ketoacidosis in pregnancy". Postgrad Med J. 79 (934): 454–7. PMC 1742779. PMID 12954957.

[urlFactors_associated_with_the_presence_of_diabetic_ketoacidosis_at_diagnosis_of_diabetes_in_children_and_young_adults:_a_systematic_review_|_The_BMJ-12] "Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review | The BMJ".

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