Roughly one in five adults who are hospitalized for diabetic ketoacidosis (DKA) will be readmitted within 30 days and these individuals are more likely to die during their second hospital stay, according to new research. "Diabetic ketoacidosis is a feared complication of type 1 diabetes because it can lead to a diabetic coma and death. But we were surprised to find that the readmission rate after diabetic ketoacidosis treatment is so high," lead investigator Dr. Hafeez Shaka, with John H. Stroger Jr. Hospital of Cook County, Chicago, said in a statement from ENDO 2021, the Endocrine Society's annual meeting. Using the National Readmissions Database, Dr. Shaka and colleagues identified 91,401 adults with type 1 diabetes who were admitted to hospitals in the United States for DKA during 2017 and discharged alive. A total of 18,553 of these patients, or 20.2%, were readmitted to the hospital within 30 days, primarily due to another episode of DKA, Dr. Shaka reported at the conference. Compared with the first DKA admission, a readmission within 30 days was associated with over two times the mortality rate (risk ratio 2.06; 95% confidence interval: 1.74 to 2.43; P<0.001). The second admission for DKA lasted one day longer on average than the index admission and generated significantly higher health care costs, he said. Dr. Shaka noted that women were more likely than men to be readmitted, as were patients who left the hospital against medical advice during the first admission. Other independent risk factors for readmission included having anemia, hypertension or chronic kidney disease. "Efforts should be channeled toward identifying these predictors in hospitalized patients with diabetic ketoacidosis as well as ensuring proper discharge planning to decrease the burden of readmissions," Dr. Shaka told the conference. The study had no commercial funding and the authors have no relevant disclosures. —Megan Brooks Source
