Risk of death following admission to a UK hospital with diabetic ketoacidosis

Abstract

Aims/hypothesisThe aim of this study was to assess the risk of death during hospital admission for diabetic ketoacidosis (DKA) and, subsequently, following discharge. In addition, we aimed to characterise the risk factors for multiple presentations with DKA.MethodsWe conducted a retrospective cohort study of all DKA admissions between 2007 and 2012 at a university teaching hospital. All patients with type 1 diabetes who were admitted with DKA (628 admissions of 298 individuals) were identified by discharge coding. Clinical, biochemical and mortality data were obtained from electronic patient records and national databases. Follow-up continued until the end of 2014.ResultsCompared with patients with a single DKA admission, those with recurrent DKA (more than five episodes) were diagnosed with diabetes at an earlier age (median 14 [interquartile range 9–23] vs 24 [16–34] years, p < 0.001), had higher levels of social deprivation (p = 0.005) and higher HbA1c values (103 [89–108] vs 79 [66–96] mmol/mol; 11.6% [10.3–12.0%] vs 9.4% [8.2–10.9%], p < 0.001), and tended to be younger (25 [22–36] vs 31 [23–42] years, p = 0.079). Antidepressant use was greater in those with recurrent DKA compared with those with a single episode (47.5% vs 12.6%, p = 0.001). The inpatient DKA mortality rate was no greater than 0.16%. A single episode of DKA was associated with a 5.2% risk of death (4.1 [2.8–6.0] years of follow-up) compared with 23.4% in those with recurrent DKA admissions (2.4 [2.0–3.8] years of follow-up) (HR 6.18, p = 0.001).Conclusions/interpretationRecurrent DKA is associated with substantial mortality, particularly among young, socially disadvantaged adults with very high HbA1c levels.Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-016-4034-0) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state

“…196,197 The Centers for Disease 198 and mortality risk is substantially increased in patients with chronically poor glycemic control and recurrent DKA. 199,200 Cerebral injury is the major cause of mortality and morbidity 195,201 and cerebral edema accounts for 60% to 90% of all DKA deaths. 102,202 From 10% to 25% of survivors of cerebral edema have significant residual morbidity.…”

“…A number of possible reasons have been proposed for the reduction in diabetes‐related deaths in children, including improved diabetes care and treatment, increased awareness of diabetes symptoms, possibly resulting in earlier recognition and treatment, and advances in education regarding diabetes and management of DKA. However, recent data show that DKA is still the leading cause of death in subjects with T1D diagnosed less than 15 years of age and mortality risk is substantially increased in patients with chronically poor glycemic control and recurrent DKA …”

Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients

“…Patients admitted to hospital with diabetic ketoacidosis represent a group at high risk for all cause mortality and hospital readmissions including recurrent diabetic ketoacidosis 13103104105. Those with a history of psychiatric illness or alcohol or substance misuse are at even higher risk for readmission, which contributes to long term risk for death 106107.…”

Treatment of Diabetic Ketoacidosis (DKA)/Hyperglycemic Hyperosmolar State (HHS): Novel Advances in the Management of Hyperglycemic Crises (UK Versus USA)

“…In Birmingham, UK, high-dose insulin was also being used with similar success—doses varying depending on the degree of consciousness, with those unarousable on admission given doses between 500 and 1400 units per 24 h [4]. DKA remains a medical emergency; over time, mortality has continued to fall but remains a significant risk, especially amongst the young, socially isolated and when care provision is fragmented [5•, 6•]. Overall, the diagnosis and treatment of DKA are very similar in the UK and USA with a few differences.…”