Diabetic ketosis during hyperglycemic crisis is associated with decreased all-cause mortality in patients with type 2 diabetes mellitus


Patients with type 2 diabetes mellitus have impaired ketogenesis due to high serum insulin and low growth hormone levels. Evidence exists that ketone bodies might improve kidney and cardiac function. In theory, improved ketogenesis in diabetics may have positive effects. We aimed to assess the impact of diabetic ketosis on all-cause mortality in patients with type 2 diabetes mellitus presenting with hyperglycemic crisis. We analyzed 486 patients with diabetic ketosis and 486 age and sex-matched patients with non-ketotic hyperglycemia presenting to the emergency department. Cox proportional hazard models were used to analyze the link between patient characteristics and mortality. During an observation time of 33.4 months, death of any cause occurred in 40.9 % of the non-ketotic hyperglycemia group and 30.2 % of the DK group (hazard ratio in the diabetic ketosis group, 0.63; 95 % confidence interval 0.48–0.82; P = 0.0005). Patients with diabetic ketosis had a lower incidence of symptomatic heart failure and had improved renal function. They used less furosemide and antihypertensive drugs, more metformin and lower insulin doses, all of which was independently associated with decreased mortality. Plasma glucose and glycated hemoglobin levels were similar in both groups. Patients with hyperglycemic crisis and diabetic ketosis have decreased all-cause mortality when compared to those with non-ketotic hyperglycemia. diabetic ketosis might be a compensatory mechanism rather than a complication in patients with hyperglycemic crises, but further prospective studies are warranted.

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We wish to thank Dr. Lora S. Kirigin for English language editing. All authors fulfill the criteria for authorship: IK gave the idea for the study, performed statistical analysis, participated in manuscript drafting and gave the final approval. MĆ and PĆ performed the data acquisition, critically reviewed the manuscript and gave the final approval. VO and MŠ designed electronic databases, participated in manuscript drafting and gave their final approval. AŠ and MV gave advice regarding statistical analyses and data acquisition, critically reviewed the manuscript and gave the final approval.


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Correspondence to Ivan Kruljac.

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Kruljac, I., Ćaćić, M., Ćaćić, P. et al. Diabetic ketosis during hyperglycemic crisis is associated with decreased all-cause mortality in patients with type 2 diabetes mellitus. Endocrine 55, 139–143 (2017). https://doi.org/10.1007/s12020-016-1082-7

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  • Type 2 diabetes mellitus
  • Ketosis
  • Ketogenesis
  • Mortality
  • Heart failure
  • Kidney disease