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. 2022 Aug 24:13:940990.
doi: 10.3389/fendo.2022.940990. eCollection 2022.

Lifetime risk and health-care burden of diabetic ketoacidosis: A population-based study

Fahim Ebrahimi  1   2   3 , Alexander Kutz  4   5 , Emanuel Remigius Christ  2   3 , Gabor Szinnai  3   6
Affiliations

Lifetime risk and health-care burden of diabetic ketoacidosis: A population-based study

Fahim Ebrahimi et al. Front Endocrinol (Lausanne). .

Abstract

Objective: Diabetic ketoacidosis (DKA) is a life-threatening complication of both type 1 and type 2 diabetes. We aimed to assess population-based rates, trends and outcomes of patients with DKA.

Design and methods: This is a nationwide cohort study using hospital discharge claims data from 2010 to 2018 in Switzerland. Incidence rates and in-hospital outcomes of DKA were analyzed throughout lifetime for children (0-9 years), adolescents (10-19 years), and adults (20-29, 30-59, and 60-90 years). Analyses were stratified for type of diabetes mellitus and sex.

Results: In total, 5,544 hospitalizations with DKA were identified, of whom 3,847 were seen in patients with type 1 diabetes and 1,697 in type 2 diabetes. Incidence rates of DKA among patients with type 1 diabetes were highest during adolescence with 17.67 (girls) and 13.87 (boys) events per 100,000 person-years (incidence rate difference [IRD]: -3.80 [95% CI, -5.59 to -2.02]) and decreased with age in both sexes thereafter. Incidence rates of DKA in patients with type 2 diabetes were low up to an age of 40 years and rose to 5.26 (females) and 6.82 (males) per 100,000 person-years in adults aged 60-90 years. Diabetic ketoacidosis was associated with relevant health-care burden independent of age, sex, or type of diabetes. The population-based incidence rate of DKA increased over time from 7.22 per 100,000 person-years in 2010 to 9.49 per 100,000 person-years in 2018.

Conclusions: In type 1 diabetes highest incidence rates of DKA hospitalizations were observed among adolescent females. In comparison, in patients with type 2 diabetes the risk for DKA steadily increased with age with higher rates in adult males. Over the 9 year study period, incidence rates of DKA were increasing irrespective of type of diabetes. DKA was associated with a high burden of disease reflected by high rates of intensive care unit admission, prolonged hospital stay and high mortality rates, especially in elderly.

Keywords: coma (diabetic); hyperglycemic crisis; ketoacidosis (DKA); type 1 diabetes mellitus (T1D); type 2 diabetes mellitus.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Lifetime Incidence Rates of Diabetic Ketoacidosis by Sex. Incidence rates per 100,000 person-years for male (blue) and female (red) patients.
Figure 2
Figure 2
Incidence Rates of Diabetic Ketoacidosis. Incidence rates for diabetic ketoacidosis per 100,000 person-years for (A) female or (B) male patients with type 1 or type 2 diabetes, respectively. For both sexes, highest incidences for patients with type 1 diabetes occur within the adolescence and remain low from the age of 30 years. In patients with type 2 diabetes, incidences for ketoacidosis are lower and slowly increase with age from 30 with a peak around the age of 85 years.
Figure 3
Figure 3
Trends of Ketoacidosis Incidence by Age, Sex, and Type of Diabetes. Shown are incidence rates per 100,000 person-years for an event of diabetic ketoacidosis for three time periods: 2010-2012 (light blue); 2013-2015 (dark blue); 2016-2018 (orange).
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References

    1. Wolfsdorf JI, Glaser N, Agus M, Fritsch M, Hanas R, Rewers A, et al. . ISPAD clinical practice consensus guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes (2018) 19:155–77. doi: 10.1111/pedi.12701 - DOI - PubMed
    1. Dhatariya KK, Glaser NS, Codner E, Umpierrez GE. Diabetic ketoacidosis. Nat Rev Dis Prim (2020) 6(1):40. doi: 10.1038/s41572-020-0165-1 - DOI - PubMed
    1. Holman N, Wild SH, Gregg EW, Valabhji J, Sattar N, Khunti K, et al. . Comparison of mortality in people with type 1 and type 2 diabetes by age of diagnosis: An incident population-based study in England and Wales. Lancet Diabetes Endocrinol (2021) 10:95–97. doi: 10.1016/S2213-8587(21)00293-X - DOI - PubMed
    1. Tittel SR, Sondern KM, Weyer M, Poeplau T, Sauer BM, Schebek M, et al. . Multicentre analysis of hyperglycaemic hyperosmolar state and diabetic ketoacidosis in type 1 and type 2 diabetes. Acta Diabetol (2020) 57(10):1245–53. doi: 10.1007/s00592-020-01538-0 - DOI - PMC - PubMed
    1. Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care (2009) 32(7):1335–43. doi: 10.2337/dc09-9032 - DOI - PMC - PubMed

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