Rate and Predictors of 30-day Readmission Following Diabetic Ketoacidosis in Type 1 Diabetes Mellitus: A US Analysis

Abstract

Introduction This study aimed to describe rates and characteristics of non-elective 30-day readmission among adult patients with diabetes mellitus type 1 (T1DM) hospitalized for diabetic ketoacidosis (DKA) and also identify predictors of readmission. Methods The study analyzed the 2018 Nationwide Readmission Database. DKA hospitalizations in patients with T1DM were classified using ICD-10-CM codes. We utilized Chi-square tests to compare baseline characteristics between readmissions and index hospitalizations. Multivariable cox regression was employed to identify independent predictors of readmission. Following this, we developed a 30-day readmission risk scoring system based on independent predictors. Results The 30-day all-cause readmission rate for DKA was 19.4%. A majority of patients (64.8%) had DKA as the principal diagnosis on readmission. Readmitted patients had a significantly higher mean age (35.3 vs. 34.9 years, p=0.018) and a higher proportion of females (52.8 vs. 49.6%,p<0.001) compared to the index admission. Readmission following DKA was associated with higher odds of inpatient mortality (0.69 vs. 0.24%, OR: 2.84, 95% CI: 1.99 – 4.06, p<0.001). Independent predictors of 30-day all-cause readmission included female sex, index hospitalizations with Charlson Comorbidity Index (CCI) score of 3 or greater, and being discharged against medical advice (AMA). Conclusion The readmission rate for DKA in T1DM patients is high, and most patients have DKA as the principal diagnosis on readmission. A CCI equal to or greater than 3, hypertension, female sex, and being discharged AMA were significant predictors of readmission.

Management of hospitalized patients with mild to moderate diabetic ketoacidosis using a continuous insulin infusion protocol on a medical surgical ward and observation level of care: A retrospective cohort study

“…[11] While predictors and causes for readmission among patients hospitalized for DKA are multifactorial and require further study, previous studies have shown this population to be at high readmission risk and have elucidated some of these risk factors including preexisting medical comorbidities, age, malnutrition, and leaving against medical advice. [11,12] Thus, investigation on multidisciplinary interventions to mitigate risk and prevent readmissions in DKA patients is needed. Additional limitations include potential downstream crossover in levels of care that may be unaccounted for; a considerable proportion of SRO patients (31.8%) with mild-to-moderate DKA managed in the ICU for reasons not addressed; and patients admitted to Med Surg at SRF without an established nonICU continuous insulin infusion protocol in place.…”

Comorbidities in Recent-Onset Adult Type 1 Diabetes: A Comparison of German Cohorts

“…Recent studies further these findings by analyzing the rate of readmission for diabetic ketoacidosis in type 1 diabetes. Multiple concomitant complications, hypertension, female sex, and incompliance towards medical advice were significant predictors of readmission (32).…”

A Revised Comorbidity Model for Administrative Databases Using Clinical Classifications Software Refined Variables

“…A model based on CCSR categories present in the DPG file was mapped from disease groups in the Sundararajan's adaptation of the modified Deyo's CCI [15]. We included smoking history, obesity, malnutrition, and anemia as variables that have impacted mortality in prior HCUP studies [20][21][22]. Mortality is a common outcome of administrative database analysis, which has demonstrated high reliability in coding [23].…”