RESUMO
AIMS: To compare diabetes patients with hyperglycaemic hyperosmolar state (HHS), diabetic ketoacidosis (DKA), and patients without decompensation (ND). METHODS: In total, 500,973 patients with type 1 or type 2 diabetes of all ages registered in the diabetes patient follow-up (DPV) were included. Analysis was stratified by age (≤ / > 20 years) and by manifestation/follow-up. Patients were categorized into three groups: HHS or DKA-during follow-up according to the most recent episode-or ND. RESULTS: At onset of diabetes, HHS criteria were met by 345 (68.4% T1D) and DKA by 9824 (97.6% T1D) patients. DKA patients had a lower BMI(-SDS) in both diabetes types compared to ND. HbA1c was higher in HHS/DKA. During follow-up, HHS occurred in 1451 (42.2% T1D) and DKA in 8389 patients (76.7% T1D). In paediatric T1D, HHS/DKA was associated with younger age, depression, and dyslipidemia. Pump usage was less frequent in DKA patients. In adult T1D/T2D subjects, metabolic control was worse in patients with HHS/DKA. HHS and DKA were also associated with excessive alcohol intake, dementia, stroke, chronic kidney disease, and depression. CONCLUSIONS: HHS/DKA occurred mostly in T1D and younger patients. However, both also occurred in T2D, which is of great importance in the treatment of diabetes. Better education programmes are necessary to prevent decompensation and comorbidities.
Assuntos
Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Cetoacidose Diabética/epidemiologia , Hiperglicemia/epidemiologia , Coma Hiperglicêmico Hiperosmolar não Cetótico/epidemiologia , Adolescente , Adulto , Idoso , Áustria/epidemiologia , Criança , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Cetoacidose Diabética/sangue , Cetoacidose Diabética/complicações , Feminino , Seguimentos , Alemanha/epidemiologia , Humanos , Hiperglicemia/sangue , Hiperglicemia/complicações , Coma Hiperglicêmico Hiperosmolar não Cetótico/sangue , Coma Hiperglicêmico Hiperosmolar não Cetótico/complicações , Luxemburgo/epidemiologia , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Suíça/epidemiologia , Adulto JovemRESUMO
Fistulas into the large vessels are a rare cause of intestinal bleeding. In some cases they are caused by transmural perforation after the accidental swallowing of a sharp foreign body like a bone or a fish bone. We report about a 79-year-old patient who had swallowed a fragment of a wooden meat skewer which induced a perforation of the oesophagus and aorta walls. The patient was admitted to the hospital with signs of severe gastrointestinal bleeding. The emergency endoscopic examination confirmed the cause of the bleeding, but the patient died during the intervention from haemorrhagic shock. The forensic autopsy confirmed the clinical suspicion of an aorto-oesophageal fistula.
