Clinical outcomes in patients with isolated or combined diabetic ketoacidosis and hyperosmolar hyperglycemic state: a retrospective, hospital-based cohort study
Open accessAbstract
Objective Many patients with hyperglycemic crises present with combined features of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). The implications of concomitant acidosis and hyperosmolality are not well known. We investigated hospital outcomes in patients with isolated or combined hyperglycemic crises. Research design and methods We analyzed admissions data listing DKA or HHS at two academic hospitals. We determined 1 ) the frequency distributions of HHS, DKA, and combined DKA-HHS (DKA criteria plus elevated effective osmolality); 2 ) the relationship of markers of severity of illness and clinical comorbidities with 30-day all-cause mortality; and 3 ) the relationship of hospital complications associated with insulin therapy (hypoglycemia and hypokalemia) with mortality. Results There were 1,211 patients who had a first admission with confirmed hyperglycemic crises criteria, 465 (38%) who had isolated DKA, 421 (35%) who had isolated HHS, and 325 (27%) who had combined features of DKA-HHS. After adjustment for age, sex, BMI, race, and Charlson Comorbidity Index score, subjects with combined DKA-HHS had higher in-hospital mortality compared with subjects with isolated hyperglycemic crises (adjusted odds ratio [aOR] 2.7; 95% CI 1.4, 4.9; P = 0.0019). In all groups, hypoglycemia ( P = 0.02). Conclusions Combined DKA-HHS is associated with higher mortality compared with isolated DKA or HHS. Severe hypokalemia and severe hypoglycemia are associated with h…
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DKA and HHS often present concurrently, though few studies have examined mixed DKA-HHS events.
“Additionally, DKA and HHS often present concurrently (168), though few studies have examined mixed DKA-HHS events.”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [168]
Inpatient mortality for mixed DKA-HHS is higher than mortality for HHS or DKA alone.
“The only study to have examined inpatient mortality for mixed DKA-HHS found it to be higher than mortality for HHS or DKA alone (168).”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [168]
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- Authors
- Pasquel, F. J., Tsegka, K., Wang, H., Cardona, S., Galindo, R. J., Fayfman, M., Davis, G., Vellanki, P., Migdal, A., Gujral, U., Narayan, K. M. V., & Umpierrez, G. E.
- Affiliations
- Emory University (US)
- Corresponding author
- Pasquel, Francisco J.
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2019-11-08
- Volume
- 43
- Issue
- 2
- Pages
- 349-357
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC6971788
- OpenAlex
- W2987621482
- Cited by
- 161
- References
- 0
- Citations by year
- 2026: 17 · 2025: 42 · 2024: 36 · 2023: 13 · 2022: 20 · 2021: 22 · 2020: 11
- FWCI
- 10.76
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Diabetes Care (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UL1TR002378)
- National Institute of General Medical Sciences (K23GM128221)
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK113241, P30DK111024)
- National Center for Advancing Translational Sciences
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12HD085850)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- diabetic ketoacidosis, hyperosmolar hyperglycemic state, in-hospital mortality, hypoglycemia, hypokalemia, insulin therapy complications, comorbidities
- MeSH terms
- Adult, Aged, Female, Hospitalization, Hospitals, Humans, Hyperglycemic Hyperosmolar Nonketotic Coma, Insulin, Male, Middle Aged, Prognosis, Retrospective Studies, United States, Cohort Studies, Comorbidity, Diabetic Ketoacidosis, Hospital Mortality, Young Adult, Insulin, Regular, Human
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