Disparities in Outcomes and Health Care Utilization for Diabetic Ketoacidosis Among Patients With Type 1 and Type 2 Diabetes Mellitus: A 6-Year National Retrospective Cohort Study

Abstract

Objective: Diabetic ketoacidosis (DKA) represents a significant burden on the health care system. The impact of diabetes type on DKA outcomes remains unclear. This study aims to compare mortality, length of stay (LOS), and hospital costs between patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM) hospitalized with DKA.

Methods: We conducted a retrospective cohort study using data from the 2016-2021 National Inpatient Sample Healthcare Cost and Utilization Project database, focusing on patients admitted for acute care with a diagnosis of DKA. Patients were categorized into 2 cohorts: T1DM versus T2DM. The primary end point was mortality, assessed using multiple logistic regression. Secondary end points included LOS and total hospital charges, analyzed using multiple linear regression, adjusting for potential confounders. Multiple imputations accounted for missing data, and a Bonferroni correction was applied for multiple comparisons.

Results: The study included 1 244 184 patients, with 770 109 (62%) T1DM and 474 075 (38%) T2DM. Mortality was significantly higher in patients with T2DM (0.91%) compared to patients with T1DM (0.22%; P < .001). LOS was longer for patients with T2DM (average 3.92 days vs 3.02 days for T1DM; P < .001), as were hospital charges ($10 146.78 for T2DM vs $7811.98 for T1DM; P < .001). Significant disparities were also observed in the demographic and hospital characteristics, including median household income, insurance type, and hospital region.

Conclusion: In this national retrospective cohort study, patients with T2DM and DKA had higher mortality rates, longer LOS, and higher health care costs than those with T1DM. These findings highlight critical disparities that may guide future interventions to improve DKA outcomes in patients with T2DM.

Keywords: diabetic ketoacidosis; disparities; health care utilization; hospital charges; length of hospital stay; mortality; type 1 diabetes mellitus; type 2 diabetes mellitus.