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World J Exp Med. Mar 20, 2026; 16(1): 117464
Published online Mar 20, 2026. doi: 10.5493/wjem.v16.i1.117464
Published online Mar 20, 2026. doi: 10.5493/wjem.v16.i1.117464
Diabetic ketoacidosis in patients with type 2 diabetes: Risk factors for mortality and adverse outcomes
Vishnu Chandrabalan, Timothy Howcroft, Department of Data Science, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
Mohammed Khalid Alkhalifah, Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
Mohammed Khalid Alkhalifah, Department of Family Medicine and Polycliniccs, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
Noorulanne Younis, Ebrahim Aldhafiri, Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, Lancashire, United Kingdom
Joseph M Pappachan, Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
Joseph M Pappachan, Department of Endocrinology and Metabolism, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India
Joseph M Pappachan, Department of Endocrinology and Metabolism, Countess of Chester Hospital NHS Trust, Chester CH2 1UL, United Kingdom
Author contributions: Chandrabalan V and Pappachan JM conceptualized the study; Howcroft T and Alkhalifah MK formulated the methodology; Younis N, Aldhafiri E, and Howcroft T were involved in the literature search, study selection, and data extraction; Chandrabalan V and Howcroft T performed statistical analysis; Alkhalifah MK, Younis N, and Aldhafiri E drafted the initial manuscript under supervision of Pappachan JM; all authors contributed to the revision and approved the final manuscript.
Institutional review board statement: The study was approved by the Institutional Review Board (No. DIAB/CA/2021-22/03).
Informed consent statement: The study is based on a retrospective data analysis and therefore, no patient consent is required.
Conflict-of-interest statement: Authors have no competing interests to declare in relation to this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author on email request.
Corresponding author: Joseph M Pappachan, MD, FRCP, MRCP, Professor, Senior Researcher, Faculty of Science, Manchester Metropolitan University, All-Saints Building, Manchester M15 6BH, United Kingdom. drpappachan@yahoo.co.in
Received: December 24, 2025
Revised: January 11, 2026
Accepted: February 5, 2026
Published online: March 20, 2026
Processing time: 97 Days and 16 Hours
Revised: January 11, 2026
Accepted: February 5, 2026
Published online: March 20, 2026
Processing time: 97 Days and 16 Hours
Core Tip
Core Tip: Diabetic ketoacidosis (DKA) resulting from type 2 diabetes mellitus (T2DM) is less common. A retrospective analysis of 464 patients from a tertiary-care United Kingdom hospital with DKA and T2DM identified that mortality rates at 30 and 90 days were 13.4% and 11% respectively after the index DKA event. The survival after the DKA event was only 58.6% on long-term follow-up. Coexistent peripheral vascular disease, congestive heart failure, and lower estimated glo