Identification des facteurs prédictifs de la cétoacidose chez le sujet diabétique hospitalisé au CHU de Pointe-à-Pitre

Abstract : Introduction. Ketoacidosis is the first acute metabolic complications of poorly controlled diabetes. The objective of this study was to describe the profile of patients in decompensation and define predictors of ketoacidosis in type 1 diabetic patients (T1D) and type 2 (T2D) in Guadeloupe. Patient and Method. Retrospective study of 201 diabetics over 18 years old, hospitalized between January 2015 and December 2015 at the University Hospital of Pointe-à-Pitre. The clinical and laboratory characteristics of patients, the incidence of ketosis and ketoacidosis, the potantial predictive factors of ketoacidosis and ketosis were analyzed in all subjects. Results. Subjects were predominantly T2D, male (50.75% men) and younger than the general population of diabetics in Guadeloupe. The mean age was 53.54 ± 17.15 years. Frequency ketoacidosis during the study was 15.07%. 149 (74.13%) subjects presented ketosis and 52 (25.87%) subjects ketoacidosis. The frequency of obesity, hypertension and dyslipidemia was 35.45%, 47.26% and 61.19% respectively. T2D patients with ketosis were significantly older (58.69 ± 14.96) than patients with ketoacidosis (50.45 ± 17.98) . The sex (OR = 21.48), the age (OR = 1.10), the duration of diabetes (OR = 0.84), the history of dyslipidemia (OR = 8.16) and a history of ketoacidosis (OR = 0.13) were significantly associated with the occurrence of ketoacidosis in type 1 diabetic. In DT2, after multivariate analysis, only HBA1c (OR = 2.00) was associated with severe ketosis. Age (OR = 1.05) and duration of diabetes (OR = 1.17) were significantly associated with ketoacidosis after adjustment to sex and age.Conclusion. The best knowledge of predictive factors of ketoacidosis would allow us to precociously identify subjects with high risk of morbidity and mortality linked to ketoacidosis. Our results need to be confirmed by prospective study to clarify and identify predictors factors of ketoacidosis. It will be helpful to adapt the preventive and curative management of diabetic subjects
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Master Thesis
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Ingrid Cirederf. Identification des facteurs prédictifs de la cétoacidose chez le sujet diabétique hospitalisé au CHU de Pointe-à-Pitre. Médecine humaine et pathologie. 2016. ⟨dumas-01622895⟩

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