Journal Article

Diabetic ketoacidosis and hyperglycaemic hyperosmolar syndrome in patients with cancer: A multicentre study

Ahmed, Shahid, Yadav, Sunil, Haider, Qasem, Le, Duc, Shahid, Rabia K.

2025

Overview

•This retrospective cohort study evaluated 33 consecutive hospitalized adult patients with an active cancer and diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar syndrome (HHS).•Patients with active cancer and DKA/HSS were relatively older and most had an advanced cancer. In about one-third cancer patients, DKA or HHS was the presenting manifestation of new onset diabetes.•Overall, 30 % patients died. Administration of a systemic cancer treatment within 30 days of admission was associated with an odd ratio of hospital mortality of 3.0 (0.62–14.8).•It is important to recognize DKA and HHS early in symptomatic cancer patients undergoing treatment to promptly initiate appropriate care and avoid inferior outcomes. Diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar syndrome (HHS) are life-threatening complications of diabetes mellitus. However, limited data about DKA and HHS are available in patients with cancer. The current study aimed to determine characteristics and outcomes of patients with cancer who were admitted with DKA/HHS in a mid-size Canadian city. Consecutive adult patients with an active cancer who were admitted with DKA or HHS from January 2008 to December 2020 in the city of Saskatoon, Saskatchewan, Canada were retrospectively evaluated. A univariate logistic regression analysis was performed to examine the correlation of various clinical variables with hospital mortality. During the study period 6,555 patients with diabetes and cancer were admitted in one of the three tertiary care hospitals. Among them 33 (0.5 %) eligible patients with DKA or HHS with a median age of 60 years (range 36–94 years) were identified. In 36 % of patients, DKA or HHS was the presenting manifestation of newly diagnosed diabetes. Of all patients, 66 % developed DKA and 73 % had an advanced cancer. Overall, 52 % patients received a systemic cancer therapy prior to the admission, and 41 % received steroids. Ten (42 %) of 24 patients with an advanced cancer died, compared to none of the nine patients with an early-stage cancer (p = 0.032). No clinical factors significantly correlated with hospital mortality. Although DKA or HHS is uncommon in patients with diabetes and cancer, it is the manifestation of undiagnosed diabetes in about one-third of patients with cancer. It has been associated with high hospital mortality in patients with advanced cancer. [Display omitted]

• Publisher: Elsevier Ltd,Royal College of Physicians,Elsevier
• Subject: Acidosis / Advanced cancer / Cancer / Cancer therapies / Cancer treatment / Cardiovascular disease / Chemotherapy / Comorbidity / Diabetes / Diabetes complications / Diabetes mellitus / Diabetic ketoacidosis / Hospital mortality / Hyperglycaemia hyperosmolar syndrome / Hyperglycemia / Immunotherapy / Metabolism / Mortality / Original Research / Patients / Population / Regression analysis / Statistical analysis