Hospitalization for DKA in T1D ups readmission and subsequent mortality risk

About one-fifth of adults with type 1 diabetes (T1D) who are hospitalized for diabetic ketoacidosis (DKA) have a risk of hospital readmission within a month of discharge. Furthermore, those who are readmitted have an elevated risk of in-hospital mortality, according to a study presented at ENDO 2021.

The researchers used data from the US-based National Readmission Database to identify adults with T1D who were hospitalized due to DKA between January and November 2017. A total of 91,625 hospital admissions for DKA were documented after excluding elective or traumatic hospitalizations, of which 91,401 were discharged alive.

Of the patients discharged alive, 20.2 percent (n=18,553) were readmitted to hospital, primarily due to DKA, within 30 days. [ENDO 2021, session OR09]

Thirty-day readmission to hospital was tied to an elevated mortality risk, twofold compared with index admission (risk ratio, 2.06, 95 percent confidence interval [CI], 1.74–2.43; p<0.001).

Readmission was also associated with a mean 1 day longer stay in hospital (p<0.001) and additional hospitalization charges (USD 8,217; p<0.001).

Readmission was more likely in female patients (hazard ratio [HR], 1.14, 95 percent CI, 0.74–1.20), as well as among individuals who left the hospital against medical advice (HR, 1.54, 95 percent CI, 1.43–1.66; p<0.001 for both).

While the reason for the increased readmission risk in women is unknown, patients who leave the hospital against medical advice may not receive information on glucose management, which is normally dispensed at hospital discharge, suggested lead author Dr Hafeez Shaka from the John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, US.

Certain comorbidities were also associated with an increased risk of readmission including hypertension (HR, 1.28, 95 percent CI, 1.20–1.35), chronic kidney disease (HR, 1.13, 95 percent CI, 1.04–1.22), and anaemia (HR, 1.42, 95 percent CI, 1.34–1.51; p<0.001 for all). Conversely, obesity (HR, 0.70, 95 percent CI, 0.62–0.79; p<0.001) and hyperlipidaemia (HR, 0.92, 95 percent CI, 0.87–0.98; p=0.007) were associated with a lower risk of readmission for DKA.

“DKA … is common in T1D as insulin deficiency promotes lipolysis and ketogenesis,” said Shaka. “[Although] DKA is a feared complication of T1D because it can lead to a diabetic coma and death, … we were surprised to find that the readmission rate after DKA treatment is so high,” he said.

One of the potential reasons for the high readmission rates could be a lack of follow-up with a diabetes care provider following hospital discharge. Additionally, patients who experience DKA are at an increased risk of repeat episodes, he said.

“Efforts should be channelled toward identifying the risk factors for readmission in hospitalized adult patients with DKA as well as ensuring proper discharge planning to decrease the burden of readmissions,” concluded Shaka.