Which Patients With Diabetes and Ketoacidosis Face Higher Death Risk?

NEW ORLEANS — Patients with type 2 diabetes (T2D) hospitalized for ketoacidosis had a higher mortality rate versus patients with type 1 diabetes (T1D), according to a study of national data.

In the retrospective study, the mortality rate for those with T2D and diabetic ketoacidosis (DKA) came in at 0.85% versus 0.2% for those with T1D and DKA (P<0.001), reported Shellsea Portillo Canales, MD, of St. Louis University Hospital.

Patients with T2D and DKA also saw a longer length of stay (LOS) in the hospital and incurred higher hospital charges compared with those with T1D and DKA, Portillo Canales told MedPage Today at a poster presentation at the American Association of Clinical Endocrinology annual meeting. Specifically, her group found that for T2D versus T1D (P<0.001 for both):

• LOS: 3.81 vs 2.97 days
• Hospital charges: Average $40,433 vs $29,873

“These findings suggest the need for targeted healthcare strategies to address these disparities and improve patient outcomes, emphasizing the importance of personalized care approaches tailored to the specific needs of patients with different types of diabetes,” she stated.

Portillo Canales and colleagues used data from the 2016-2020 National Inpatient Sample Healthcare Cost and Utilization Project Database, and divided patients into two cohorts based on their diabetes type. The study’s primary endpoint of mortality was obtained using multiple logistic regression analysis.

The researchers reported other significant disparities between the two cohorts for multiple factors, including median household income, insurance type, hospital region, bed size, for-profit status, and teaching hospital status.

Portillo Canales noted that patients with T2D more were likely to have comorbidities or complications. For instance, about 45% had a hypertension diagnosis versus 25% of patients with T1D, while about 24% versus 8%, respectively, had obesity, and 8% versus 4% had chronic obstructive pulmonary disease (P<0.001 for all). However, more patients with T1D had an end-stage renal disease diagnosis compared with T2D patients (4% vs 3%, P<0.001).

She explained that “even though we tried to correct for many of these variables, we believe that the outcomes are worse for T2D patients because they have so many more comorbidities,” adding that increased age and higher Charlson Comorbidity Index scores were seen among the those with T2D and DKA in their analysis.

However, Samarth Virmani, MBBS, of Houston Methodist Hospital, advised caution when interpreting the data regarding higher mortality for patients with T2D, DKA, and other comorbidities. The study does not specify “the types of therapy patients may have received, and who was treating them,” he pointed out.

“Some hospitalists, encountering a younger [patient with T1D and DKA], might be more aggressive in their treatment approach in order to prevent complications and death…I am sure that comorbidities play a major role, but there are other factors that need to be considered as well,” Virmani, who was not involved in the study, told MedPage Today.

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