{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T02:49:00Z","timestamp":1791859740936,"version":"4.3.4"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T00:00:00Z","timestamp":1694476800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T00:00:00Z","timestamp":1694476800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Endocr Disord"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Diabetic ketoacidosis (DKA) was once known to be specific to type-1 diabetes-mellitus (T1D); however, many cases are now seen in patients with type-2 diabetes-mellitus (T2D). Little is known about how this etiology shift affects DKA's outcomes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We studied consecutive index DKA admissions from January 2015 to March 2021. Descriptive analyses were performed based on pre-existing T1D and T2D (PT1D and PT2D, respectively) and newly diagnosed T1D and T2D (NT1D and NT2D, respectively).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of the 922 patients, 480 (52%) had T1D, of which 69% had PT1D and 31% NT1D, whereas 442 (48%) had T2D, of which 60% had PT2D and 40% NT2D. The mean age was highest in PT2D (47.6\u2009\u00b1\u200913.1\u00a0years) and lowest in PT1D (27.3\u2009\u00b1\u20090.5\u00a0years) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Patients in all groups were predominantly male except in the PT1D group (55% females) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Most patients were Arabic (76% in PT1D, 51.4% in NT1D, 46.6% in PT2D) except for NT2D, which mainly comprised Asians (53%) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Patients with NT2D had the longest hospital length of stay (LOS) (6.8\u2009\u00b1\u200911.3\u00a0days) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), longest DKA duration (26.6\u2009\u00b1\u200921.1\u00a0h) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), and more intensive-care unit (ICU) admissions (31.2%) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Patients with PT1D had the shortest LOS (2.5\u2009\u00b1\u20093.5\u00a0days) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), DKA duration (18.9\u2009\u00b1\u20094.2\u00a0h) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), and lowest ICU admissions (16.6%) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions\/interpretation<\/jats:title>\n                <jats:p>We presented the largest regional data on differences in DKA based on the type and duration of diabetes- mellitus (DM), showing that T2D is becoming an increasing cause of DKA, with worse clinical outcomes (especially newly diagnosed T2D) compared to T1D.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12902-023-01446-8","type":"journal-article","created":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T04:01:54Z","timestamp":1694491314000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Differential evolution of diabetic ketoacidosis in adults with pre-existent versus newly diagnosed type 1 and type 2 diabetes mellitus"],"prefix":"10.1186","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7121-8574","authenticated-orcid":false,"given":"Fateen","family":"Ata","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1583-1539","authenticated-orcid":false,"given":"Adeel Ahmad","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2887-9726","authenticated-orcid":false,"given":"Ibrahim","family":"Khamees","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6321-3092","authenticated-orcid":false,"given":"Baian Z. M.","family":"Mohammed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6472-648X","authenticated-orcid":false,"given":"Haidar Hussein","family":"Barjas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9594-0964","authenticated-orcid":false,"given":"Bassam","family":"Muthanna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3096-2641","authenticated-orcid":false,"given":"Mohammed","family":"Bashir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5199-8382","authenticated-orcid":false,"given":"Anand","family":"Kartha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,9,12]]},"reference":[{"issue":"3","key":"1446_CR1","doi-asserted-by":"publisher","first-page":"259","DOI":"10.4158\/EP-2018-0551","volume":"26","author":"AC Xu","year":"2020","unstructured":"Xu AC, Broome DT, Bena JF, Lansang MC. Predictors for adverse outcomes in diabetic ketoacidosis in a multihospital health system. Endocr Pract. 2020;26(3):259\u201366.","journal-title":"Endocr Pract"},{"issue":"8","key":"1446_CR2","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1097\/00007611-198508000-00012","volume":"78","author":"PE Gouin","year":"1985","unstructured":"Gouin PE, Gossain VV, Rovner DR. Diabetic ketoacidosis: outcome in a community hospital. South Med J. 1985;78(8):941\u20133.","journal-title":"South Med J"},{"issue":"7","key":"1446_CR3","doi-asserted-by":"publisher","first-page":"e016587","DOI":"10.1136\/bmjopen-2017-016587","volume":"7","author":"S Fazeli Farsani","year":"2017","unstructured":"Fazeli Farsani S, 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.","journal-title":"BMJ Open"},{"issue":"4","key":"1446_CR4","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1002\/pdi.1852","volume":"31","author":"A Puttanna","year":"2014","unstructured":"Puttanna A, Padinjakara R. Diabetic ketoacidosis in type 2 diabetes mellitus. Practical Diabetes. 2014;31(4):155\u20138.","journal-title":"Practical Diabetes"},{"issue":"4","key":"1446_CR5","doi-asserted-by":"publisher","first-page":"198","DOI":"10.2337\/diaclin.22.4.198","volume":"22","author":"BJ Welch","year":"2004","unstructured":"Welch BJ, Zib I. Case study: diabetic ketoacidosis in type 2 diabetes: \u201cLook Under the Sheets.\u201d Clin Diabetes. 2004;22(4):198\u2013200.","journal-title":"Clin Diabetes"},{"issue":"1","key":"1446_CR6","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1186\/s13098-016-0186-9","volume":"8","author":"V Thibault","year":"2016","unstructured":"Thibault V, B\u00e9langer M, LeBlanc E, Babin L, Halpine S, Greene B, Mancuso M. Factors that could explain the increasing prevalence of type 2 diabetes among adults in a Canadian province: a critical review and analysis. Diabetol Metab Syndr. 2016;8(1):71.","journal-title":"Diabetol Metab Syndr"},{"issue":"1","key":"1446_CR7","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1186\/s13052-022-01264-z","volume":"48","author":"S Passanisi","year":"2022","unstructured":"Passanisi S, Salzano G, Aloe M, Bombaci B, Citriniti F, De Berardinis F, De Marco R, Lazzaro N, Lia MC, Lia R, et al. Increasing trend of type 1 diabetes incidence in the pediatric population of the Calabria region in 2019\u20132021. Ital J Pediatr. 2022;48(1):66.","journal-title":"Ital J Pediatr"},{"issue":"1","key":"1446_CR8","doi-asserted-by":"publisher","first-page":"107","DOI":"10.2991\/jegh.k.191028.001","volume":"10","author":"MAB Khan","year":"2020","unstructured":"Khan MAB, Hashim MJ, King JK, Govender RD, Mustafa H, Al Kaabi J. Epidemiology of type 2 diabetes - global burden of disease and forecasted trends. J Epidemiol Glob Health. 2020;10(1):107\u201311.","journal-title":"J Epidemiol Glob Health"},{"issue":"1","key":"1446_CR9","doi-asserted-by":"publisher","first-page":"e000044","DOI":"10.1136\/bmjdrc-2014-000044","volume":"3","author":"SH Song","year":"2015","unstructured":"Song SH. Complication characteristics between young-onset type 2 versus type 1 diabetes in a UK population. BMJ Open Diabetes Res Care. 2015;3(1):e000044.","journal-title":"BMJ Open Diabetes Res Care"},{"issue":"1","key":"1446_CR10","doi-asserted-by":"publisher","first-page":"e8","DOI":"10.1016\/j.diabres.2009.04.017","volume":"85","author":"MK Kim","year":"2009","unstructured":"Kim MK, Lee SH, Kim JH, Lee JI, Kim JH, Jang EH, Yoon KH, Lee KW, Song KH. Clinical characteristics of Korean patients with new-onset diabetes presenting with diabetic ketoacidosis. Diabetes Res Clin Pract. 2009;85(1):e8-11.","journal-title":"Diabetes Res Clin Pract"},{"issue":"3","key":"1446_CR11","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1007\/s00125-004-1336-4","volume":"47","author":"MY Donath","year":"2004","unstructured":"Donath MY, Halban PA. Decreased beta-cell mass in diabetes: significance, mechanisms and therapeutic implications. Diabetologia. 2004;47(3):581\u20139.","journal-title":"Diabetologia"},{"issue":"17","key":"1446_CR12","doi-asserted-by":"publisher","first-page":"1925","DOI":"10.1001\/archinte.164.17.1925","volume":"164","author":"CA Newton","year":"2004","unstructured":"Newton CA, Raskin P. Diabetic ketoacidosis in type 1 and type 2 diabetes mellitus: clinical and biochemical differences. Arch Intern Med. 2004;164(17):1925\u201331.","journal-title":"Arch Intern Med"},{"issue":"9","key":"1446_CR13","doi-asserted-by":"publisher","first-page":"1870","DOI":"10.2337\/dc17-1583","volume":"41","author":"VW Zhong","year":"2018","unstructured":"Zhong VW, Juhaeri J, Mayer-Davis EJ. Trends in hospital admission for diabetic ketoacidosis in adults with type 1 and type 2 diabetes in England, 1998\u20132013: a retrospective cohort study. Diabetes Care. 2018;41(9):1870\u20137.","journal-title":"Diabetes Care"},{"issue":"1","key":"1446_CR14","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1186\/s12902-021-00922-3","volume":"22","author":"A Charoenpiriya","year":"2022","unstructured":"Charoenpiriya A, Chailurkit L, Ongphiphadhanakul B. Comparisons of biochemical parameters and diabetic ketoacidosis severity in adult patients with type 1 and type 2 diabetes. BMC Endocr Disord. 2022;22(1):7.","journal-title":"BMC Endocr Disord"},{"issue":"7","key":"1446_CR15","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.2337\/dc09-9032","volume":"32","author":"AE Kitabchi","year":"2009","unstructured":"Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32(7):1335\u201343.","journal-title":"Diabetes Care"},{"key":"1446_CR16","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.ejim.2019.03.014","volume":"63","author":"L Barski","year":"2019","unstructured":"Barski L, Eshkoli T, Brandstaetter E, Jotkowitz A. Euglycemic diabetic ketoacidosis. Eur J Intern Med. 2019;63:9\u201314.","journal-title":"Eur J Intern Med"},{"issue":"2","key":"1446_CR17","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1136\/bmjdrc-2021-002451","volume":"9","author":"E Ooi","year":"2021","unstructured":"Ooi E, Nash K, Rengarajan L, Melson E, Thomas L, Johnson A, Zhou D, Wallett L, Ghosh S, Narendran P, et al. Clinical and biochemical profile of 786 sequential episodes of diabetic ketoacidosis in adults with type 1 and type 2 diabetes mellitus. BMJ Open Diabetes Res Care. 2021;9(2):e002451.","journal-title":"BMJ Open Diabetes Res Care."},{"key":"1446_CR18","doi-asserted-by":"publisher","first-page":"940990","DOI":"10.3389\/fendo.2022.940990","volume":"13","author":"F Ebrahimi","year":"2022","unstructured":"Ebrahimi F, Kutz A, Christ ER, Szinnai G. Lifetime risk and health-care burden of diabetic ketoacidosis: a population-based study. Front Endocrinol (Lausanne). 2022;13:940990.","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"1","key":"1446_CR19","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s40842-021-00127-6","volume":"7","author":"R Lyerla","year":"2021","unstructured":"Lyerla R, Johnson-Rabbett B, Shakally A, Magar R, Alameddine H, Fish L. Recurrent DKA results in high societal costs - a retrospective study identifying social predictors of recurrence for potential future intervention. Clin Diabetes Endocrinol. 2021;7(1):13.","journal-title":"Clin Diabetes Endocrinol"},{"issue":"12","key":"1446_CR20","doi-asserted-by":"publisher","first-page":"1655","DOI":"10.1111\/dme.13808","volume":"35","author":"A Gopalan","year":"2018","unstructured":"Gopalan A, Mishra P, Alexeeff SE, Blatchins MA, Kim E, Man AH, Grant RW. Prevalence and predictors of delayed clinical diagnosis of Type 2 diabetes: a longitudinal cohort study. Diabet Med. 2018;35(12):1655\u201362.","journal-title":"Diabet Med"},{"issue":"5","key":"1446_CR21","doi-asserted-by":"publisher","first-page":"7691","DOI":"10.18632\/aging.202593","volume":"13","author":"M Zhu","year":"2021","unstructured":"Zhu M, Liu X, Liu W, Lu Y, Cheng J, Chen Y. \u03b2 cell aging and age-related diabetes. Aging (Albany NY). 2021;13(5):7691\u2013706.","journal-title":"Aging (Albany NY)"},{"issue":"1","key":"1446_CR22","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1007\/s00125-021-05543-y","volume":"65","author":"RB Prasad","year":"2022","unstructured":"Prasad RB, Asplund O, Shukla SR, Wagh R, Kunte P, Bhat D, Parekh M, Shah M, Phatak S, K\u00e4r\u00e4j\u00e4m\u00e4ki A, et al. Subgroups of patients with young-onset type 2 diabetes in India reveal insulin deficiency as a major driver. Diabetologia. 2022;65(1):65\u201378.","journal-title":"Diabetologia"},{"issue":"11","key":"1446_CR23","first-page":"548","volume":"25","author":"MS Fragala","year":"2019","unstructured":"Fragala MS, Shiffman D, Birse CE. Population health screenings for the prevention of chronic disease progression. Am J Manag Care. 2019;25(11):548\u201353.","journal-title":"Am J Manag Care"},{"issue":"1","key":"1446_CR24","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1186\/s12902-019-0421-0","volume":"19","author":"Y Mamo","year":"2019","unstructured":"Mamo Y, Bekele F, Nigussie T, Zewudie A. Determinants of poor glycemic control among adult patients with type 2 diabetes mellitus in Jimma University Medical Center, Jimma zone, south west Ethiopia: a case control study. BMC Endocr Disord. 2019;19(1):91.","journal-title":"BMC Endocr Disord"},{"issue":"8","key":"1446_CR25","doi-asserted-by":"publisher","first-page":"e005710","DOI":"10.1136\/bmjopen-2014-005710","volume":"4","author":"J Hwang","year":"2014","unstructured":"Hwang J, Shon C. Relationship between socioeconomic status and type 2 diabetes: results from Korea National Health and Nutrition Examination Survey (KNHANES) 2010\u20132012. BMJ Open. 2014;4(8):e005710.","journal-title":"BMJ Open"},{"issue":"33","key":"1446_CR26","doi-asserted-by":"publisher","first-page":"4137","DOI":"10.3748\/wjg.15.4137","volume":"15","author":"S Kawahito","year":"2009","unstructured":"Kawahito S, Kitahata H, Oshita S. Problems associated with glucose toxicity: role of hyperglycemia-induced oxidative stress. World J Gastroenterol. 2009;15(33):4137\u201342.","journal-title":"World J Gastroenterol"},{"key":"1446_CR27","unstructured":"Qatar National Diabetes Strategy 2016\u20132022. https:\/\/andp.unescwa.org\/plans\/1236."}],"container-title":["BMC Endocrine Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-023-01446-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12902-023-01446-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-023-01446-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,17]],"date-time":"2023-11-17T17:08:58Z","timestamp":1700240938000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcendocrdisord.biomedcentral.com\/articles\/10.1186\/s12902-023-01446-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,12]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["1446"],"URL":"https:\/\/doi.org\/10.1186\/s12902-023-01446-8","relation":{},"ISSN":["1472-6823"],"issn-type":[{"value":"1472-6823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,12]]},"assertion":[{"value":"23 January 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 August 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 September 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This work is original, has not been, and is not under consideration for publication in any other Journal. The study was conducted in full compliance with the principles of the \u201cDeclaration of Helsinki,\u201d Good Clinical Practice (GCP) and other relevant guidelines. The study protocol was approved by the ethics committee of Medical Research Center (MRC) Qatar (MRC-01\u201321-476). The need for informed consent was waived by Medical Research Center (MRC) Qatar considering the retrospective nature of data review.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"193"}}