Issue: June 2021
Disclosures: Li reports he is an employee of Sanofi. Please see the study for all other authors’ relevant financial disclosures.
April 29, 2021
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DKA rates decrease after 7-year rise

Issue: June 2021
Disclosures: Li reports he is an employee of Sanofi. Please see the study for all other authors’ relevant financial disclosures.
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Incidence rates of diabetic ketoacidosis in the U.S. decreased by an average of 6.1% in 2018 and 2019 after increasing from 2011 to 2017, according to a study published in the Journal of Diabetes and Its Complications.

“This study provides up-to-date estimates of incidence of DKA and its trends in a large U.S. commercially insured population with type 1 diabetes over a study period of 13 years, with implications for care planning and drug development,” Lin Li, MD, PhD, a pharmacoepidemiologist at Sanofi in Bridgewater, New Jersey, and colleagues wrote. “The data reaffirmed that the incidence of DKA was higher in the pediatric and female populations. Furthermore, the data showed that age-sex-standardized incidence of DKA significantly decreased during 2018-2019 after a steady increase since 2011.”

DKA cases declined by an average of 6.1% annually in 2018 and 2019 after increasing in each of the previous 7 years. Data were derived from Li L, et al. J Diabetes Complications. 2021;doi:10.1016/j.jdiacomp.2021.107932.

Researchers conducted a retrospective cohort study analyzing patient data from the IBM MarketScan database. Data on U.S. residents of all ages with type 1 diabetes were obtained from 2007 to 2019. Researchers extracted hospitalized DKA events occurring any time from index data to the end of follow-up. Consecutive DKA occurrences were considered distinct events if they were separated by at least 14 days.

The study included 455,423 people with type 1 diabetes (mean age, 38.9 years). The mean follow-up time was 2.7 years. The overall incidence rate of DKA from 2007 to 2019 was 55.5 cases per 1,000 person-years. The rate was higher for women and girls (62.9 cases per 1,000 person-years) compared with men and boys (48.6 cases per 1,000 person-years). Youths aged 10 to 19 years had the highest DKA incidence rates of any age group for both sexes, whereas adults aged 80 years or older had the lowest rates of any age group for both sexes.

After adjusting for age and sex, incidence rates of DKA decreased by a mean annual rate of 4% from 2007 to 2010, falling from 64.6 cases per 1,000 person years in 2007 to 54.1 per 1,000 person-years in 2010. From 2011 to 2017, DKA rates increased at an average annual rate of 2.9%, topping out at 67.3 cases per 1,000 person-years in 2017. DKA incidence rates fell by an average of 6.1% in the final 2 years of the study to 65.2 cases per 1,000 person-years in 2018 and 60.4 cases per 1,000 person-years in 2019.

“Although the causes for the increase in 2011-2017 are unclear, several possible explanations have been proposed, including changes in DKA case definition, increased hospitalization for mild DKA cases, and new antihyperglycemic medications that might increase the risk of DKA, such as sodium-glucose cotransporter 2 inhibitors,” the researchers wrote. “The triggers for the decrease in 2018-2019 are also unclear.”

The researchers said more study is needed to see whether the decrease in DKA cases continued in 2020 and how much of an impact the COVID-19 pandemic has on DKA trends.