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Comparing patient characteristics and outcomes in type 1 versus type 2 diabetes with diabetic ketoacidosis: a review and a propensity-matched nationwide analysis
  1. Hafeez Shaka1,
  2. Farah Wani2,
  3. Zain El-Amir3,
  4. Dushyant Singh Dahiya3,
  5. Jagmeet Singh4,
  6. Ehizogie Edigin1,
  7. Precious Eseaton5,
  8. Asim Kichloo6
  1. 1 Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
  2. 2 Department of Internal Medicine, Samaritan Medical Center, Watertown, New York, USA
  3. 3 Department of Internal Medicine, Central Michigan University, Saginaw, Michigan, USA
  4. 4 Department of Internal Medicine, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
  5. 5 Department of Medicine and Surgery, University of Benin, Benin City, Edo, Nigeria
  6. 6 CMU Medical Education Partners, Saginaw, Michigan, USA
  1. Correspondence to Dr Hafeez Shaka, John H Stroger Hospital of Cook County, Chicago, IL 60612, USA; sagehafeez{at}gmail.com

Abstract

Diabetic ketoacidosis (DKA) is a known complication of patients with type 1 diabetes mellitus (T1DM), but less common in type 2 diabetes mellitus (T2DM). The aim of this study was to compare the outcomes of patients admitted to the hospital with DKA in T1DM versus T2DM. This was a population-based, retrospective, cohort study using data from the Nationwide Inpatient Sample. The group of patients hospitalized for DKA was divided based on a secondary diagnosis of either T1DM or T2DM. The primary outcome was inpatient mortality, and the secondary outcomes were rate of complications, length of hospital stay (LOS) and total hospital charge (THC). The inpatient mortality for DKA was 0.27% (650 patients). In T2DM, the adjusted OR (aOR) for mortality was 2.13 (95% CI 1.38 to 3.28, p=0.001) with adjusted increase in mean THC of $6035 (95% CI 4420 to 7652, p<0.001) and mean LOS of 0.5 day (95% CI 0.3 to 0.6, p<0.001) compared with T1DM. Patients with T2DM had significantly higher odds of having septic shock (aOR 2.02, 95% CI 1.160 to 3.524, p=0.013) compared with T1DM. T2DM was associated with higher inpatient mortality, septic shock and increase in healthcare utilization costs compared with T1DM.

  • endocrinology
  • diabetes complications
  • diabetes mellitus

Data availability statement

Data are available in a public, open-access repository. We used and/or analyzed the NIS database 2016 and 2017, available online at http://www.hcup-us.ahrq.gov. The NIS is a large publicly available all-payer inpatient care database in the USA, containing data on more than 7 million hospital stays yearly. Its large sample size is ideal for developing national and regional estimates and enables analyses of rare conditions, uncommon treatments, and special populations.

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Data availability statement

Data are available in a public, open-access repository. We used and/or analyzed the NIS database 2016 and 2017, available online at http://www.hcup-us.ahrq.gov. The NIS is a large publicly available all-payer inpatient care database in the USA, containing data on more than 7 million hospital stays yearly. Its large sample size is ideal for developing national and regional estimates and enables analyses of rare conditions, uncommon treatments, and special populations.

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Footnotes

  • Contributors HS and AK are credited with substantial contribution to the design of the work, acquisition and interpretation of the data, drafting the manuscript, statistical analysis, and revision of important intellectual content. FW and ZEA are credited with substantial contribution to interpretation of data, literature review of all sections discussed, and drafting of the manuscript. JS and DSD are credited with interpretation of the data, literature review of all sections, and revision of important intellectual content. EE and PE are credited with interpretation of data, literature review, specifically for the discussion section, and revision of the work for critically important intellectual content. All authors are credited with final approval of the version published and agreement of accountability for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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