OBJECTIVES Much of the research previously done on diabetic ketoacidosis (DKA) was based on a young population with type 1 diabetes mellitus (type 1 DM). But substantial numbers of DKA episodes occur in patients with a prior history of type 2 diabetes mellitus (type 2 DM). There is a lack of Data are lacking about DKA in older adults. The aims of this study were to analyze the clinical characteristics and outcomes of older adult patients with DKA. DESIGN Retrospective matched cohort study of adult patients hospitalized with DKA between 2004 and 2017. SETTING Soroka University Medical Center, Be'er Sheva, Israel. PARTICIPANTS The clinical characteristics of DKA patients 65 years and older were compared with patients younger than 65 years. MEASUREMENTS The primary outcome was in‐hospital mortality. RESULTS The study cohort included 385 consecutive patients for whom the admission diagnosis was DKA: 307 patients (79.7%) younger than 65 years (group 1), and 78 patients (20.3%) older than 65 years (group 2). Patients in group 2 compared with group 1 had a significantly higher Charlson index (6 [6–6] vs 6 [6–7]; P < .0001) and DM with target organ damage (24.4% vs 6.2%; P < .0001). Patients in group 2 compared with group 1 had more serious disease according to results of laboratory investigations. The total in‐hospital mortality rate of patients in group 2 was 16.7% compared with 1.6% in patients in group 1 in a sex and co‐morbidities matched analysis (P = .001). CONCLUSIONS DKA in older adults is a common problem. The serious co‐morbidities and precipitating factors such as infection/sepsis, myocardial infarction, and cerebrovascular accidents, may explain the severity of the problem of DKA in older adults and the high rate of mortality of these patients. DKA appears to be a lifethreatening condition in older adults. The alertness of physicians to DKA in older adults, timely diagnosis, proper treatment, and prevention are cornerstones of care. J Am Geriatr Soc 68:1256–1261, 2020.

Background Diabetic ketoacidosis (DKA) is an acute metabolic condition, sometimes requiring admission to an intensive care unit (ICU). Aims To investigate the outcomes of DKA patients admitted to a hospital with restricted ICU capacity. Methods We included all DKA patients above age 18 who were admitted to a tertiary hospital during 2004–2017. We conducted multivariate logistic regression analysis adjusted for ICU bed availability to analyse parameters associated with ICU admission, and a composite outcome of mortality, DKA recurrence and mechanical ventilation. Results Among 382 DKA patients in our cohort, 94 (24.6%) were admitted to the ICU. The in‐hospital mortality was 4.7%. Low bicarbonate (<10 mmoL/L) and pH (<7) levels at presentation were associated with ICU admission (P < 0.001 for both). In multivariate models availability of beds in the ICU was not associated with ICU admission, mortality or DKA recurrence of any type. Conclusion In a setting of limited ICU capacity, DKA treatment does not necessarily require admission to the ICU. When the rising rates of diabetes mellitus and the associated elevated rates of DKA are taken into account, our results highlight the importance of including step‐down units when devising local protocols for care of these patients.

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