Just how common is relapse for diabetic ketoacidosis?

Rehabilitation is not uncommon for patients with type 1 diabetes, according to a new study.

In a study of more than 90,000 hospitals including an event of diabetic ketoacidosis (DKA), approximately 20.2% of adults were returned to the hospital within 30 days, Hafeez Shaka, MD, noted. of Cook County Hospital in Chicago, a statement at the ENDO Meaningful Endocrine Society Meeting 2021.

And there was a fifth higher rate of patients with type 1 diabetes who were rehabilitated within 30 days while rehospitalized (risk ratio 2.06, 95% CI 1.74-2.43, P.<0.001), the study showed.

This finding reflects badly on the glucose control of these patients, Shaka explained at a news conference, saying the high readmission rate was “quite alarming.”

“And this [data] just looking at the 30 – day window, “he said, noting that readmission rates for this patient population are likely to be much higher if the window is extended beyond a month.

Re-admission for DKA or similar hyperglycemic crisis was also associated with an average 1-day longer hospital stay compared with the index entry (95% CI 0.9–1.2, P.<0.001), he said.

Also compared to the index entry, re-approval for DKA was tied to an average of $ 8,217 (95% CI $ 6,940- $ 9,492, P.<0.001) increased costs of health care use.

Many factors also suggested that some patients were returned within a month for DKA, Shaka said. This included being a female patient (HR 1.14, 95% CI 1.74–1.20, P.<0.001), and it is not surprising that it was previously released against medical advice (HR 1.54, 95% CI 1.43–1.66, P.<0.001).

Specific comorbidities were also predictors of recombination for DKA, including hypertension (HR 1.28, 95% CI 1.20–1.35), renal failure (HR 1.13, 95% CI 1.04–1.22). , and anemia (HR 1.42, 95% CI 1.34 –1.51).

Surprisingly, however, these type 1 diabetes patients had a lower risk of comorbid hyperlipidemia (HR 0.92, 95% CI 0.87–0.98) or obesity (HR 0.70, 95% CI 0.62 -0.79) to be reversed for DKA.

Shaka explained that in this population of patients with type 1 diabetes, obesity tended to be an indication for increased insulin compliance.

Further efforts should be put into identifying more DKA re-licensing predictors, as well as proper distribution design to reduce this re-licensing burden, he said.

The analysis drew on patient data from the National Reablement Database, covering adult hospitals between January and November 2017.

91,625 patients aged 18 and older with type 1 diabetes who were admitted for DKA were included in the analysis, and the majority were then admitted to intensive care. Of these patients, 91,401 were discharged alive. Patients were excluded if they were admitted selectively or traumatized.

Study limitations, Shaka said, included a lack of data on whether these patients were using daily multiple injections or continuous glucose monitoring in addition to insulin pumps before they were hospitalized. This was because the database only contained patient information, Shaka explained to him MedPage today.

However, regarding the monitoring of the blood glucose of these patients in the hospital, he noted, although the Endocrine Society’s own guidelines on the best management practices of hyperglycemia in non-hospital care patients urgently, most hospitals have their own protocols.