Recurrent DKA results in high societal costs – a retrospective study identifying social predictors of recurrence for potential future intervention

• Published in: Clinical diabetes and endocrinology Vol. 7; no. 1; pp. 1 - 6
• Main Authors: Lyerla, Ryan, Johnson-Rabbett, Brianna, Shakally, Almoutaz, Magar, Rekha, Alameddine, Hind, Fish, Lisa
• Format: Journal Article
• Language: English
• Published: London BioMed Central 01.08.2021; BioMed Central Ltd; BMC
• Subjects: African Americans; Age; Alcohol use; Analysis; Barriers to care; Compliance; Diabetes; Diabetic ketoacidosis; Drug abuse; Endocrinology; Ethnicity; Health aspects; Health care expenditures; Hospitalization; Inner city; Insulin; Insulin cost; Medical centers; Medicine; Medicine & Public Health; Medicine, Preventive; Mental depression; Mental disorders; Mortality; Patients; Preventive health services; Psychosis; Recurrent DKA; Research Article; Risk factors; Social aspects; Socioeconomic factors; Surveillance; United States > US; Minnesota; Recurrent DKA; Insulin cost; Barriers to care
• ISSN: 2055-8260; 2055-8260
• DOI: 10.1186/s40842-021-00127-6

Aims Diabetic ketoacidosis (DKA) is an emergency with high morbidity and mortality. This study examined patient factors associated with hospitalization for recurrent DKA. Methods Characteristics of 265 subjects admitted for DKA at Hennepin County Medical Center between January 2017 and January 2019 were retrospectively analyzed. Differences between subjects with a single admission versus multiple were reviewed. Results Forty-eight out of 265 patients had recurrent DKA. Risk factors included African American race (adjusted odds ratio (aOR) versus white non-Hispanic = 4.6, 95% CI 1.8–13, p  = 0.001) or other race/ethnicity (aOR = 8.6, 2.9–28, p  < 0.0001), younger age (aOR 37-52y versus 18-36y = 0.48, 0.19–1.16, p  = 0.10; aOR 53-99y versus 18-36y = 0.37, 0.12–0.99, p  = 0.05), type 1 diabetes mellitus (aOR = 2.4, 1.1–5.5, p  = 0.04), ever homeless (aOR = 2.5, 1.1–5.4, p  = 0.03), and drug abuse (aOR = 3.2, 1.3–7.8, p  = 0.009). DKA cost a median of $29,981 per admission. Conclusions Recurrent DKA is costly, and social determinants are strong predictors of recurrence. This study highlights the need for targeted preventative care programs.