Definition and research guide
This page combines a MeSH definition, publication statistics and selected research abstracts. It is a starting point for reading the literature, not a medical textbook or a systematic evidence review.
Content available: 4 complete abstracts (820 words), 10 references. Full article text is not stored or reproduced here; follow the PMID, DOI or PMC links to read the original sources and their access terms.
Definition
A state of unconsciousness as a complication of diabetes mellitus. It occurs in cases of extreme hyperglycemia or extreme hypoglycemia as a complication of insulin therapy.
Definition: NLM Medical Subject Headings (MeSH) scope note (Public domain (U.S. National Library of Medicine); attribution requested). View the MeSH record.
Also known as: Coma, Diabetic; Comas, Diabetic; Diabetic Comas.
Where it fits in the MeSH classification
- Broader topics
- Diabetes Complications
- Narrower topics
- Hyperglycemic Hyperosmolar Nonketotic Coma
Related concepts
- Hyperglycemia
- Hypoglycemia
- Insulin
Research landscape
PubMed indexes 2,902 records tagged with the MeSH heading “Diabetic Coma” (counts retrieved 2026-11-04). 145 of them (5.0%) were published from 2020 onward, and the busiest period so far is through 1999 with 2,347 records.
Reviews account for 291 records (10.0%) and meta-analyses for 1. Randomized controlled trials number 7 (0.2%) as a share of all records on the topic. Randomized trials make up only a small share of this literature, so much of what is known comes from laboratory, observational or descriptive work.
Show the data
| Period | Records |
|---|---|
| through 1999 | 2,347 |
| 2000-2009 | 216 |
| 2010-2019 | 194 |
| 2020 onward | 145 |
Publication-type chart data
| Type | Records | Share |
|---|---|---|
| Reviews | 291 | 10.0% |
| Meta-analyses | 1 | 0.0% |
| Randomized controlled trials | 7 | 0.2% |
Method: PubMed query "Diabetic Coma"[MeSH Terms] with publication-type and date filters, retrieved 2026-11-04.
Reading the evidence in metabolism and endocrine disease
Studies of diabetes, obesity and hormone disorders often follow blood tests such as glucose, HbA1c or hormone levels, which are stand-ins for outcomes that matter more, such as complications. Lifestyle and diet research is largely observational, and weight and diabetes trials can differ in how long people were followed. Nothing on this page is advice about medicines, insulin or diet; talk to a qualified clinician about your own situation. Check whether the outcome was a lab value or a clinical event, and the type and duration of the condition studied.
Evidence from open-access studies
These open-access studies come from PubMed’s best-match results for this heading (papers whose main topic it is), ranked here by citation count, with one recent addition. Each abstract is reproduced in full under its recorded open licence so that you can read the authors’ own words. They illustrate the literature; they are not a systematic summary of it. Citation counts measure attention, not reliability or clinical benefit.
Treatment of Diabetic Ketoacidosis (DKA)/Hyperglycemic Hyperosmolar State (HHS): Novel Advances in the Management of Hyperglycemic Crises (UK Versus USA) [1]
Abstract reading summary — source excerpts
- Opening excerpt
- Purpose of reviewDiabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are diabetic emergencies that cause high morbidity and mortality.
- Closing excerpt
- Further research needs to be done to delineate a unifying diagnostic and treatment protocol.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (146 words)
Purpose of reviewDiabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are diabetic emergencies that cause high morbidity and mortality. Their treatment differs in the UK and USA. This review delineates the differences in diagnosis and treatment between the two countries.Recent findingsLarge-scale studies to determine optimal management of DKA and HHS are lacking. The diagnosis of DKA is based on disease severity in the USA, which differs from the UK. The diagnosis of HHS in the USA is based on total rather than effective osmolality. Unlike the USA, the UK has separate guidelines for DKA and HHS. Treatment of DKA and HHS also differs with respect to timing of fluid and insulin initiation. There is considerable overlap but important differences between the UK and USA guidelines for the management of DKA and HHS. Further research needs to be done to delineate a unifying diagnostic and treatment protocol.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 28364357 · DOI · PMC5375966
Clinical profiles, outcomes and risk factors among type 2 diabetic inpatients with diabetic ketoacidosis and hyperglycemic hyperosmolar state: a hospital-based analysis over a 6-year period [2]
Abstract reading summary — source excerpts
- Opening excerpt
- ObjectiveDiabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are the two most common hyperglycemic emergencies (HEs) associated with diabetes mellitus.
- Closing excerpt
- Elevated BUN might be an independent predictor of mortality in patients with HHS, whereas CSII might be a protective factor against death in HHS.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (228 words)
ObjectiveDiabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are the two most common hyperglycemic emergencies (HEs) associated with diabetes mellitus. Individuals with HEs can present with combined features of DKA and HHS. The objective of this study is to assess the clinical characteristics, therapeutic outcomes, and associated predisposing factors of type 2 diabetic patients with isolated or combined HEs in China.MethodsWe performed a retrospective analysis of 158 patients with type 2 diabetes (T2DM), complicated with DKA, HHS, or DKA combined with HHS (DKA-HHS) in Shanghai Tongji Hospital, China from 2010 to 2015. Admission clinical features, therapeutic approaches and treatment outcomes of those patients were extracted and analyzed.ResultsOf the 158 patients with T2DM, 65 (41.1%) patients were DKA, 74 (46.8%) were HHS, and 19 (12.0%) were DKA-HHS. The most common precipitants were infections (111, 70.3%), newly diagnosed diabetes (28,17.7%) and non-compliance to medications (9, 5.7%). DKA patients were divided into mild, moderate and severe group, based on arterial blood gas. Spearman correlation analysis revealed that C-reaction protein (CRP) was positively correlated with severity of DKA, whereas age and fasting C peptide were inversely correlated with severity of DKA (P ConclusionsOur findings showed elevated CRP and decreased fasting C-peptide might serve as indicator for severe DKA. Elevated BUN might be an independent predictor of mortality in patients with HHS, whereas CSII might be a protective factor against death in HHS.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 33317485 · DOI · PMC7734851
Multicentre analysis of hyperglycaemic hyperosmolar state and diabetic ketoacidosis in type 1 and type 2 diabetes [3]
Abstract reading summary — source excerpts
- Opening excerpt
- AimsTo compare diabetes patients with hyperglycaemic hyperosmolar state (HHS), diabetic ketoacidosis (DKA), and patients without decompensation (ND).
- Closing excerpt
- Better education programmes are necessary to prevent decompensation and comorbidities.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (202 words)
AimsTo compare diabetes patients with hyperglycaemic hyperosmolar state (HHS), diabetic ketoacidosis (DKA), and patients without decompensation (ND).MethodsIn total, 500,973 patients with type 1 or type 2 diabetes of all ages registered in the diabetes patient follow-up (DPV) were included. Analysis was stratified by age (≤ / > 20 years) and by manifestation/follow-up. Patients were categorized into three groups: HHS or DKA-during follow-up according to the most recent episode-or ND.ResultsAt onset of diabetes, HHS criteria were met by 345 (68.4% T1D) and DKA by 9824 (97.6% T1D) patients. DKA patients had a lower BMI(-SDS) in both diabetes types compared to ND. HbA1c was higher in HHS/DKA. During follow-up, HHS occurred in 1451 (42.2% T1D) and DKA in 8389 patients (76.7% T1D). In paediatric T1D, HHS/DKA was associated with younger age, depression, and dyslipidemia. Pump usage was less frequent in DKA patients. In adult T1D/T2D subjects, metabolic control was worse in patients with HHS/DKA. HHS and DKA were also associated with excessive alcohol intake, dementia, stroke, chronic kidney disease, and depression.ConclusionsHHS/DKA occurred mostly in T1D and younger patients. However, both also occurred in T2D, which is of great importance in the treatment of diabetes. Better education programmes are necessary to prevent decompensation and comorbidities.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 32488499 · DOI · PMC7496062
Inavolisib-induced fulminant-like diabetes and hyperosmolar hyperglycemic state: a case report [4]
Abstract reading summary — source excerpts
- Opening excerpt
- BackgroundInavolisib, a recently approved phosphatidylinositol 3-kinase α (PI3Kα) inhibitor for advanced breast cancer, carries a notable risk of hyperglycemia.
- Closing excerpt
- Early metabolic assessment, close glucose monitoring, prompt interruption of inavolisib when clinically indicated, and rapid insulin-based management are essential for timely recognition and safe clinical care.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (244 words)
BackgroundInavolisib, a recently approved phosphatidylinositol 3-kinase α (PI3Kα) inhibitor for advanced breast cancer, carries a notable risk of hyperglycemia. Despite this established, on-target adverse effect, clinical endocrinologists often lack sufficient awareness regarding both the risk profile and the specific management strategies required for Inavolisib-induced hyperglycemia. The objective of this report is to describe a patient with fulminant-like diabetes accompanied by Hyperosmolar Hyperglycemic State (HHS) following Inavolisib administration.Case presentationA 59-year-old female patient with metastatic breast cancer developed rapid-onset and severe hyperglycemia (blood glucose: 48.0 mmol/L at emergency presentation) progressing to HHS within 72 hours of initiating Inavolisib therapy. She presented with fatigue but showed no evidence of ketoacidosis. She had no personal or family history of diabetes mellitus and multiple prior random blood glucose measurements were within normal range. Admission laboratory findings included glycated hemoglobin A1c (HbA1c) 5.7% (reference: 4.0-6.0%), fasting plasma glucose 8.6 mmol/L, fasting insulin 41.5 μU/mL (reference: 2.6-24.9 μU/mL), and fasting C-peptide 10.2 ng/mL (reference: 1.1-4.4 ng/mL), Diabetes-related autoantibodies (ICA, GADA, IAA) were negative. After discontinuation of Inavolisib and administration of intensive insulin therapy, the patient's hyperglycemia resolved rapidly.ConclusionInavolisib-induced hyperglycemia may occur abruptly after treatment initiation and can rapidly progress to severe hyperglycemic emergencies such as HHS, even in patients without known dysglycemia. Normal baseline glycemic indices do not reliably exclude the risk of severe toxicity. Early metabolic assessment, close glucose monitoring, prompt interruption of inavolisib when clinically indicated, and rapid insulin-based management are essential for timely recognition and safe clinical care.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 42181200 · DOI · PMC13194030
Key reviews and meta-analyses
The most cited review-type papers among PubMed’s best-match results for this heading, listed with bibliographic details only. Follow the links for the full text and access terms.
- Research article ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state [5]
- Research article Management of hyperglycemic crises in patients with diabetes [6]
- Research article Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia [7]
- Research article ISPAD clinical practice consensus guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state [8]
- Research article Hyperosmolar hyperglycemic state: a historic review of the clinical presentation, diagnosis, and treatment [9]
- Research article Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State [10]
References
- Dhatariya KK, Vellanki P. Treatment of Diabetic Ketoacidosis (DKA)/Hyperglycemic Hyperosmolar State (HHS): Novel Advances in the Management of Hyperglycemic Crises (UK Versus USA). . 2017. PMID 28364357 · DOI · PMC5375966
- Wu XY, She DM, Wang F, Guo G, Li R, Fang P, et al.. Clinical profiles, outcomes and risk factors among type 2 diabetic inpatients with diabetic ketoacidosis and hyperglycemic hyperosmolar state: a hospital-based analysis over a 6-year period. . 2020. PMID 33317485 · DOI · PMC7734851
- Tittel SR, Sondern KM, Weyer M, Poeplau T, Sauer BM, Schebek M, et al.. Multicentre analysis of hyperglycaemic hyperosmolar state and diabetic ketoacidosis in type 1 and type 2 diabetes. . 2020. PMID 32488499 · DOI · PMC7496062
- Li H, Cao C, Jin L, Xiao J, Zhao W, Wang X. Inavolisib-induced fulminant-like diabetes and hyperosmolar hyperglycemic state: a case report. . 2026. PMID 42181200 · DOI · PMC13194030
- Wolfsdorf JI, Glaser N, Agus M, Fritsch M, Hanas R, Rewers A, et al.. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes. 2018. PMID 29900641 · DOI
- Kitabchi AE, Umpierrez GE, Murphy MB, Barrett EJ, Kreisberg RA, Malone JI, et al.. Management of hyperglycemic crises in patients with diabetes. Diabetes Care. 2001. PMID 11194218 · DOI
- Umpierrez G, Korytkowski M. Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nat Rev Endocrinol. 2016. PMID 26893262 · DOI
- Glaser N, Fritsch M, Priyambada L, Rewers A, Cherubini V, Estrada S, et al.. ISPAD clinical practice consensus guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2022. PMID 36250645 · DOI
- Pasquel FJ, Umpierrez GE. Hyperosmolar hyperglycemic state: a historic review of the clinical presentation, diagnosis, and treatment. Diabetes Care. 2014. PMID 25342831 · DOI · PMC4207202
- Fayfman M, Pasquel FJ, Umpierrez GE. Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State. Med Clin North Am. 2017. PMID 28372715 · DOI · PMC6535398
About this article
- Sources
- NLM Medical Subject Headings (definition, synonyms); NCBI PubMed (counts, identifiers); Europe PMC (open-access abstracts and citation counts).
- Verification
- Every reference was resolved against PubMed on 2026-11-04; title, year and DOI matched.
- Review state
- automated source verified; no human expert review has been recorded yet.
- Version
- 1, last updated 2026-11-04.
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Evidence strength
EvidenceHelix's computed view of the study designs behind this topic: how common meta-analyses, randomized trials and reviews are, how recent the literature is, and a plain-language reading. It describes the design mix of the literature. It is not a quality appraisal of any study, and it is not medical advice.