Severe hypoglycaemia and diabetic ketoacidosis in adults presenting to a hospital emergency department: Adverse prognostic markers for survival in type 2 diabetes and the role of SGLT2 inhibitors
Authors' conclusion
SH and DKA events requiring hospital treatment herald a poor prognosis with greater mortality in T2D adults with multimorbidity. A significant number of DKA episodes in T2D occurred in people receiving SGLT2-i medication.
Study context
- Population
- Adults with T1D or T2D attending a hospital emergency department (ED) with severe hypoglycaemia (SH) or diabetic ketoacidosis (DKA), 1 January 2019 to 30 June 2023643 SH episodes in 515
- Exposure
- T2D vs T1D after ED presentation with SH or DKA
- Outcome
- Prognosis (long-term survival, mortality, causes of death) after SH and DKA
Methodological detailssingle ED, medical records review
- Single ED
- Medical records review
Main finding
As reported in the abstract
T2D vs T1DHazard ratio (95% CI)P value
Mortality risk after index SH
3.43(2.43–4.84)
P < 0.005Mortality risk after index DKA
3.00(1.77–5.10)
P < 0.005- After SH
- mortality 48.4% vs. 19.9%; P < 0.005
- After DKA
- mortality 30.8% vs. 13.4%; P = 0.001
- Long-term survival lower in T2D
- P < 0.005
Observational data: associations, not effects.
Further findings
| Outcome | Median time to death | P value |
|---|---|---|
| Median time to fatal outcomeT2D vs T1D · SH | 134 vs. 511 days | both p < 0.005 |
| Median time to fatal outcomeT2D vs T1D · DKA | 43 vs. 266 days | both p < 0.005 |
Event distribution and SGLT2i
- DKA predominated in T1D
- 77.6%
- SH predominated in T2D
- 54.3%
- T2D DKA events associated with SGLT2i
- 32.3%
Comorbidities
- T2D older, more comorbidities than T1D (cardiorenal disease, HF, cognitive impairment, cancer)
- all p < 0.005
- Most causes of death non-cardiovascular, irrespective of diabetes type
Original publication
Severe hypoglycaemia and diabetic ketoacidosis in adults presenting to a hospital emergency department: Adverse prognostic markers for survival in type 2 diabetes and the role of SGLT2 inhibitors. Diabet Med. Published 20 November 2024. doi:10.
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