Active use of cocaine: An independent risk factor for recurrent diabetic ketoacidosis in a city hospital

Ebenezer Nyenwe, Raghu S. Loganathan, Steve Blum, Donald O. Ezuteh, David M. Erani, Jim Wan, Marcia R. Palace, Abbas E. Kitabchi

Research output: Contribution to journalArticle

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Abstract

Objective: To identify the risk factors for recurrent diabetic ketoacidosis (DKA) in a city hospital. Methods: We performed a retrospective analysis of sequential adult admissions for DKA at Bronx Lebanon Hospital Center in New York between July 1, 2001, and June 30, 2004. The patients were divided into cohorts, which were compared with use of analysis of variance and χ2 tests. Multivariate logistic regression analysis was performed where indicated. Results: In 168 patients (96 men and 72 women), 219 episodes of DKA occurred. The mean age (±SD) of the overall study group was 38.6 ± 14.8 years. Fifty-four patients (32%) had type 2 diabetes, and 44 patients (26%) had new-onset diabetes. The recurrence rate of DKA was 169% in cocaine users and 39% in nonusers (P<0.0001). Active use of cocaine, noncompliance, and Hispanic ethnicity emerged as independent risk factors for recurrent DKA - odds ratio (OR) = 4.38, P = 0.001; OR = 1.96, P = 0.05; and OR = 0.40, P = 0.005, respectively. The commonest precipitants of DKA were noncompliance (44%) and infection (26%). Noncompliance was associated with use of cocaine, use of cannabis, and cigarette smoking (P = 0.008, 0.04, and 0.01, respectively). In 91 of the hospital admissions for DKA (42%), the patients were active smokers. Conclusion: Active use of cocaine is an independent risk factor for recurrent DKA, as are noncompliance and Hispanic ethnicity. Of these 3 factors, cocaine showed the strongest association with DKA. Therefore, toxicology screening in patients with recurrent DKA may be prudent and worthwhile.

Original languageEnglish (US)
Pages (from-to)22-29
Number of pages8
JournalEndocrine Practice
Volume13
Issue number1
DOIs
StatePublished - Jan 1 2007
Externally publishedYes

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Diabetic Ketoacidosis
Urban Hospitals
Cocaine
Odds Ratio
Hispanic Americans
Marijuana Smoking
Lebanon
Toxicology
Type 2 Diabetes Mellitus
Analysis of Variance
Logistic Models
Smoking
Regression Analysis
Recurrence

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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Active use of cocaine : An independent risk factor for recurrent diabetic ketoacidosis in a city hospital. / Nyenwe, Ebenezer; Loganathan, Raghu S.; Blum, Steve; Ezuteh, Donald O.; Erani, David M.; Wan, Jim; Palace, Marcia R.; Kitabchi, Abbas E.

In: Endocrine Practice, Vol. 13, No. 1, 01.01.2007, p. 22-29.

Research output: Contribution to journalArticle

Nyenwe, Ebenezer ; Loganathan, Raghu S. ; Blum, Steve ; Ezuteh, Donald O. ; Erani, David M. ; Wan, Jim ; Palace, Marcia R. ; Kitabchi, Abbas E. / Active use of cocaine : An independent risk factor for recurrent diabetic ketoacidosis in a city hospital. In: Endocrine Practice. 2007 ; Vol. 13, No. 1. pp. 22-29.
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abstract = "Objective: To identify the risk factors for recurrent diabetic ketoacidosis (DKA) in a city hospital. Methods: We performed a retrospective analysis of sequential adult admissions for DKA at Bronx Lebanon Hospital Center in New York between July 1, 2001, and June 30, 2004. The patients were divided into cohorts, which were compared with use of analysis of variance and χ2 tests. Multivariate logistic regression analysis was performed where indicated. Results: In 168 patients (96 men and 72 women), 219 episodes of DKA occurred. The mean age (±SD) of the overall study group was 38.6 ± 14.8 years. Fifty-four patients (32{\%}) had type 2 diabetes, and 44 patients (26{\%}) had new-onset diabetes. The recurrence rate of DKA was 169{\%} in cocaine users and 39{\%} in nonusers (P<0.0001). Active use of cocaine, noncompliance, and Hispanic ethnicity emerged as independent risk factors for recurrent DKA - odds ratio (OR) = 4.38, P = 0.001; OR = 1.96, P = 0.05; and OR = 0.40, P = 0.005, respectively. The commonest precipitants of DKA were noncompliance (44{\%}) and infection (26{\%}). Noncompliance was associated with use of cocaine, use of cannabis, and cigarette smoking (P = 0.008, 0.04, and 0.01, respectively). In 91 of the hospital admissions for DKA (42{\%}), the patients were active smokers. Conclusion: Active use of cocaine is an independent risk factor for recurrent DKA, as are noncompliance and Hispanic ethnicity. Of these 3 factors, cocaine showed the strongest association with DKA. Therefore, toxicology screening in patients with recurrent DKA may be prudent and worthwhile.",
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AU - Erani, David M.

AU - Wan, Jim

AU - Palace, Marcia R.

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N2 - Objective: To identify the risk factors for recurrent diabetic ketoacidosis (DKA) in a city hospital. Methods: We performed a retrospective analysis of sequential adult admissions for DKA at Bronx Lebanon Hospital Center in New York between July 1, 2001, and June 30, 2004. The patients were divided into cohorts, which were compared with use of analysis of variance and χ2 tests. Multivariate logistic regression analysis was performed where indicated. Results: In 168 patients (96 men and 72 women), 219 episodes of DKA occurred. The mean age (±SD) of the overall study group was 38.6 ± 14.8 years. Fifty-four patients (32%) had type 2 diabetes, and 44 patients (26%) had new-onset diabetes. The recurrence rate of DKA was 169% in cocaine users and 39% in nonusers (P<0.0001). Active use of cocaine, noncompliance, and Hispanic ethnicity emerged as independent risk factors for recurrent DKA - odds ratio (OR) = 4.38, P = 0.001; OR = 1.96, P = 0.05; and OR = 0.40, P = 0.005, respectively. The commonest precipitants of DKA were noncompliance (44%) and infection (26%). Noncompliance was associated with use of cocaine, use of cannabis, and cigarette smoking (P = 0.008, 0.04, and 0.01, respectively). In 91 of the hospital admissions for DKA (42%), the patients were active smokers. Conclusion: Active use of cocaine is an independent risk factor for recurrent DKA, as are noncompliance and Hispanic ethnicity. Of these 3 factors, cocaine showed the strongest association with DKA. Therefore, toxicology screening in patients with recurrent DKA may be prudent and worthwhile.

AB - Objective: To identify the risk factors for recurrent diabetic ketoacidosis (DKA) in a city hospital. Methods: We performed a retrospective analysis of sequential adult admissions for DKA at Bronx Lebanon Hospital Center in New York between July 1, 2001, and June 30, 2004. The patients were divided into cohorts, which were compared with use of analysis of variance and χ2 tests. Multivariate logistic regression analysis was performed where indicated. Results: In 168 patients (96 men and 72 women), 219 episodes of DKA occurred. The mean age (±SD) of the overall study group was 38.6 ± 14.8 years. Fifty-four patients (32%) had type 2 diabetes, and 44 patients (26%) had new-onset diabetes. The recurrence rate of DKA was 169% in cocaine users and 39% in nonusers (P<0.0001). Active use of cocaine, noncompliance, and Hispanic ethnicity emerged as independent risk factors for recurrent DKA - odds ratio (OR) = 4.38, P = 0.001; OR = 1.96, P = 0.05; and OR = 0.40, P = 0.005, respectively. The commonest precipitants of DKA were noncompliance (44%) and infection (26%). Noncompliance was associated with use of cocaine, use of cannabis, and cigarette smoking (P = 0.008, 0.04, and 0.01, respectively). In 91 of the hospital admissions for DKA (42%), the patients were active smokers. Conclusion: Active use of cocaine is an independent risk factor for recurrent DKA, as are noncompliance and Hispanic ethnicity. Of these 3 factors, cocaine showed the strongest association with DKA. Therefore, toxicology screening in patients with recurrent DKA may be prudent and worthwhile.

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