Prevalence of and risk factors for diabetic ketosis in Chinese diabetic patients with random blood glucose levels >13.9 mmol/L: Results from the CH ina study in prEvalence of diabetiC Ketosis ( CHECK ) study

Background The aim of the present study was to investigate the prevalence of diabetic ketosis ( DK ) and its risk factors in Chinese diabetes patients with severe hyperglycemia. Methods The present multicenter cross‐sectional study was performed on patients aged >16 years with diabetes mellitus ( DM ) and random blood glucose levels >13.9 mmol/L (>250 mg/dL). Blood ketones (β‐hydroxybutyric acid) and urinary ketones (acetoacetic acid) were measured and information on patient demographic and clinical characteristics was collected. Results Of 1235 patients enrolled in the study (93 with type 1 DM [T1 DM ]), 1142 with type 2 DM [T2 DM ]), 242 (19.6%) had DK (blood ketone levels ≥0.6 mmol/L). Proportionately, DK was more frequent and more severe in patients with T1 DM than T2 DM (55.9% vs 16.6%, respectively), but in absolute terms occurred in more patients with T2 DM (52 vs 190). In patients with blood ketone levels ≥3 mmol/L, the cut‐off point of blood glucose levels was 19.05 mmol/L. Risk factors significantly associated with higher blood ketone levels in T2 DM included younger age, a shorter duration of diabetes, and not using antidiabetic medication within 12 months prior to the hyperglycemic episode. Conclusions The prevalence of DK is lower in patients with T2 DM than T1 DM , but the number of patients with DK is higher for those with T2 DM because of more T2 DM patients in China. Patients with T2 DM who have a younger age, shorter duration of diabetes, and a lack of antidiabetic treatment will suffer from DK more often than older patients with longer T2 DM duration and receiving antidiabetic treatment.