Impacto da cetoacidose recorrente no risco de mortalidade de pacientes com diabetes mellitus do tipo 1: estudo de uma coorte brasileira

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Santos, Sarah Simaan dos [UNIFESP]
Dib, Sergio Atala [UNIFESP]
Dissertação de mestrado
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Context: Recurrent Diabetic Ketoacidosis (rDKA) is an already recognized condition that presents some peculiarities, such as associated psychosocial illnesses, non-compliance to insulin treatment and which courses with an increase in mortality.(1, 6, 8-11) Objective: To study the impact of rDKA mortality and its associated risk factors Patients and Methods: Through the analysis of the electronic database of our institution (PEP Unifesp) we accessed clinical and laboratorial data of patients hospitalized with ICD-10 E.10.1 and E14.1 that were in the fourth character for diabetic ketoacidosis of the period from January 2007 to January 2018. Of these, only those with type 1 diabetes mellitus (DM1) were included for analysis, and those with another form of diabetes, even insulin-dependent and DKA, were excluded. In total, we analyzed and managed to follow-up 231 patients, who were included in this retrospective cohort. For medium-term analysis (1823 days), follow-up was carried out through new medical appointments, phone calls and virtual contacts. For mortality analysis, we subcategorized patients with DKA into 4 groups: I) DKA at diagnosis of DM1/ DM1 Newly Diagnosed II) 1 episode of DKA during follow-up after diagnosis of DM1 III) 2-5 episodes of DKA IV) >5 episodes of DKA during follow-up. Results: A mortality rate of 16.02% (37/231) was found after hospital discharge, with age of death of 38.7 years [IQR 28.43-48.91 years], duration of diabetes of 19.2 years [IQR 13.67-23.80]. In addition, we found the number of hospitalizations (p<0.001), duration of diabetes (p<0.001), microangiopathic complications (Retinopathy, Nephropathy and Neuropathy) (p<0.001), mood disorders (p=0.001), use of antidepressants (p<0.001), statin use (p<0.001) were risk factors for the outcome of death in patients with CAD. Analyzing the CAD subgroups, it was found in the survival curve of Kaplan-Meier, there was a notable difference between those with more than two episodes in the projected period. With a projection of 1926 days (approx. 5 years) the probabilities of death were HR 7.78%; 4.58%; 24.40%; 26.63% in group I, II, III and IV, respectively. Conclusion: Patients with CADr (those with more than 2 episodes of CAD in the period analyzed) are about 4-5 times more likely to die than those who had a single episode (Group I and II). CADr is a entity that requires specific care and follow-up that should include personalized medicine and psychosocial care for individuals with DM1.
SANTOS, Sarah Simaan dos. Impacto da cetoacidose recorrente no risco de mortalidade de pacientes com diabetes mellitus do tipo 1: estudo de uma coorte brasileira. São Paulo, 2021. 97 p. Dissertação (Mestrado em Endocrinologia e Metabologia) – Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2021.