Re-admission to the hospital for DKA is associated with an increased risk of mortality in type 1 diabetes

March 25, 2021

2 min reading

Source / Discoveries

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Shaka H, ​​et al. Rate and predictor of 30-day readmission in adults with type 1 diabetes hospitalized for diabetic ketoacidosis in the United States: A national study. Presented at: ENDO annual meeting; March 20-23, 2021 (virtual meeting).

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Adults with type 1 diabetes who are hospitalized for diabetic ketoacidosis and re-admitted within 30 days of discharge have an increased risk of inpatient mortality, according to a speaker at the annual ENDO meeting.

“Approximately one-fifth of patients who had an episode of DKA with type 1 diabetes were re-admitted to the hospital within 30 days of discharge.” Hafeez Shaka, MD, a resident of internal medicine at John H. Stroger Jr. Hospital. from Cook County, Chicago, said during a news conference. “This is a considerably high number.”

Approximately one-fifth of adults hospitalized with DKA were readmitted within 30 days of discharge, and DKA readmission was associated with an increased risk of hospital mortality. Data were derived from Shaka H, ​​et al. Rate and predictor of 30-day readmission in adults with type 1 diabetes hospitalized for diabetic ketoacidosis in the United States: A national study. Presented at: ENDO annual meeting; March 20-23, 2021 (virtual meeting).

Shaka and colleagues reviewed data from the National Database on Readmission of Adults Over 18 with Type 1 Diabetes admitted to the DKA Hospital from January 1 to November 30, 2017. Elective and traumatic admissions were not included in the analysis. The primary outcomes in the analysis were 30-day readmission rates, mortality, length of hospital stay, and total hospital benefits.

There were 91,625 cases of adults with type 1 diabetes who were hospitalized with DKA during the study period, and 91,401 were discharged. Of those discharged, 20.2% were re-admitted to the hospital within 30 days, most mostly admitted to the DKA.

Adults re-admitted to DKA within 30 days of discharge had an increased risk of mortality compared with admission to the index (RR = 2.06; 95% CI, 1.74-2.43; Str <.001). Readmit adults also had an increased median length of hospital stay of 1 day (95% CI, 0.9-1.2; Str <.001) compared with first admission and mean total hospitalization costs of $ 8,217; 95% CI, 6,940-9,492; Str <.001).

In the subgroup analysis, obesity (HR = 0.7; 95% CI, 0.62-0.79; Str <.001) and hyperlipidemia (HR = 0.92; 95% CI, 0.87-0.98; Str = .0007) were associated with a lower risk of DKA readmission.

“Obesity seemed to be protective in this case because obesity could be a substitute marker for patients who were traditionally more in line with insulin, because as we know in patients with type 1 diabetes, they need insulin to store body fat,” he said. is Shaka. “Most of these patients who are poorly controlled tend to be either underweight or within normal limits. Patients who are more in line with their insulin, they are the ones who are overweight and have a lipid disorder. “

Hypertension, chronic kidney disease, and anemia were independent predictors of DKA readmission. Women and those discharged for medical advice during the first hospitalization also had a higher risk of readmission.

“These factors should be recognized early on [initial] admission as a way to significantly prevent readmission, which most hospitals strive to work on and which would also help reduce morbidity and mortality in patients with type 1 diabetes, ”Shaka said.

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