The Endocrine Society

The Endocrine Society

Source:

Shaka H, et al. Rate and predictor of 30-day readmission in adults with type 1 diabetes hospitalized for diabetic ketoacidosis in the U.S.: A nationwide study. Presented at: ENDO annual meeting; March 20-23, 2021 (virtual meeting).

Disclosures: Shaka reports no relevant financial disclosures.
March 25, 2021
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Hospital readmission for DKA associated with increased mortality risk in type 1 diabetes

Source:

Shaka H, et al. Rate and predictor of 30-day readmission in adults with type 1 diabetes hospitalized for diabetic ketoacidosis in the U.S.: A nationwide study. Presented at: ENDO annual meeting; March 20-23, 2021 (virtual meeting).

Disclosures: Shaka reports no relevant financial disclosures.
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Adults with type 1 diabetes who are hospitalized for diabetic ketoacidosis and readmitted within 30 days of discharge have an increased risk for inpatient mortality, according to a speaker at the ENDO annual meeting.

“About one-fifth of patients who had an episode of DKA with type 1 diabetes get readmitted back to the hospital within 30 days of discharge,” Hafeez Shaka, MD, an internal medicine resident at the John H. Stroger Jr. Hospital of Cook County, Chicago, said during a press conference. “This is a significantly high number.”

About one-fifth of adults hospitalized with DKA are re-admitted within 30 days of discharge, and DKA readmission is associated with an increased risk for in-hospital mortality. Data are derived from Shaka H, et al. Rate and predictor of 30-day readmission in adults with type 1 diabetes hospitalized for diabetic ketoacidosis in the U.S.: A nationwide study. Presented at: ENDO annual meeting; March 20-23, 2021 (virtual meeting).

Shaka and colleagues reviewed data from the National Readmission Database of adults aged 18 years or older with type 1 diabetes who were admitted to a hospital for DKA from Jan. 1 to Nov. 30, 2017. Elective and traumatic admissions were not included in the analysis. Primary outcomes in the analysis were 30-day readmission rates, mortality, length of hospital stay and total hospital charges.

There were 91,625 cases of adults with type 1 diabetes who were hospitalized with DKA during the study period, with 91,401 being discharged. Of those who were discharged, 20.2% were readmitted to the hospital within 30 days, most principally readmitted for DKA.

Adults readmitted for DKA within 30 days of discharge had an increased risk for mortality compared with index admission (RR = 2.06; 95% CI, 1.74-2.43; P < .001). Readmitted adults also had an increased mean length of stay in the hospital of 1 day (95% CI, 0.9-1.2; P < .001) compared with the first admission and mean total hospitalization charges of $8,217 (95% CI, 6,940-9,492; P < .001).

In subgroup analysis, obesity (HR = 0.7; 95% CI, 0.62-0.79; P < .001) and hyperlipidemia (HR = 0.92; 95% CI, 0.87-0.98; P = .0007) were associated with a lower risk for DKA readmission.

“Obesity seemed to be protective in this case because obesity might be a surrogate marker of patients who had been traditionally more compliant with insulin, because as we know in patients with type 1 diabetes, they need insulin to store body fat,” Shaka said. “Most of these patients who are poorly controlled tend to be either underweight or within the normal limit. Patients who are being more compliant with their insulin, they are the patients that tend to be more overweight and have a lipid disorder.”

Hypertension, chronic kidney disease and anemia were independent predictors for DKA readmission. Women and those who were discharged against medical advice during their first hospitalization also had a higher risk for readmission.

“These factors should be identified early during the [initial] admission as a way of significantly preventing readmission, which is something most hospitals tend to work on and something that would also help reduce the morbidity and mortality in patients with type 1 diabetes,” Shaka said.