W. Wei, F. Shi, J. Liang, Y. Chen, H. Wang and S. Zhang (2026). Incidence and risk factors for diabetic ketoacidosis in hypertriglyceridemia-induced acute pancreatitis patients ‒ A retrospective study. Revista espanola de enfermedades digestivas, 118(7), 389-391. https://doi.org/10.17235/reed.2025.11587/2025

PubMed 41128108

[Abstract]
BACKGROUND AND AIMS: the occurrence of diabetic ketoacidosis (DKA), along with its risk factors and pathophysiological mechanisms, remains incompletely understood. This study aimed to evaluate the clinical features of DKA in patients with hypertriglyceridemia-induced acute pancreatitis (HTAP) and identify independent risk factors for the development of DKA in a Chinese cohort.

METHODS: patients diagnosed with HTAP from January 2021 to December 2024 were retrospectively enrolled and divided into the DKA group and the non-DKA group. Demographic data, clinical features, admission laboratory findings, and clinical courses were compared between the two groups. The Least Absolute Shrinkage and Selection Operator (LASSO) and multivariate logistic regression analyses were performed to explore independent risk factors for DKA development.

RESULTS: a total of 221 HTAP patients were enrolled, of whom 14.9 % (33 patients) had concomitant DKA. Blood glucose, hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), neutrophil count (NEUT %), procalcitonin (PCT), total cholesterol (TC), aspartate aminotransferase (AST), C-reactive protein (CRP), red cell distribution width (RDW), and modified CT severity index (MCTSI) were obtained. All of these factors showed statistically significant differences between the two groups (p < 0.05) in a comparison of baseline characteristics. Additionally, patients in the DKA group were more likely to have type 2 diabetes mellitus (T2DM), severe acute pancreatitis (SAP) and longer hospital stays. The LASSO regression and multivariate logistic analysis identified SAP, T2DM history, and elevated HbA1c as independent risk factors for DKA development in HTAP patients.

CONCLUSION: in patients with HTAP, the relatively high incidence of DKA demands the attention of emergency clinicians. HTAP patients with SAP, a history of T2DM and poor HbA1c control should be considered at high-risk for developing DKA. However, prospective, multicenter, large-sample studies will be needed in the future to validate our findings.