Diabetic ketoacidosis in patients with type 2 diabetes: Risk factors for mortality and adverse outcomes.

BACKGROUND

Diabetic ketoacidosis (DKA) resulting from type 2 diabetes mellitus (T2DM) is less common, and the factors associated with adverse outcomes and mortality are not well established based on large-scale studies.

AIM: To identify the risk factors for adverse outcomes and mortality in treated patients with DKA in T2DM.

METHODS

Retrospective analysis of patients admitted to a tertiary-care hospital in the United Kingdom with DKA and T2DM for inpatient management between January 2010 to September 2024 to identify the clinical profile, demographic features, and laboratory parameters impacting treatment outcomes and survival.

RESULTS

Four hundred and sixty-four patients were included. Of these 395 (85.13%) were White, 266 (57.3%) were males with a mean age at presentation of 61.3 (17.6) years, median inpatient hospital stay of 5 (interquartile range: 3-10.3) days, and a mean glycated HbA1c of 89.3 (30) mmol/mol. The 30-day and 90-day mortality were 13.4% and 11% respectively after the index DKA event. The long-term survival after the DKA event was only 58.6%. Presence of cerebrovascular disease [odds ratio (OR): 6.75; 95%CI: 0.76-12.74], use of sodium glucose cotransporter 2 inhibitors (OR: 5.8; 95%CI: 1.32-9.62), chronic obstructive pulmonary disease (OR: 3.6; 95%CI: 2.14-6.44), higher national early warning score 2 score (OR: 1.14; 95%CI: 0.10-2.18) and low systolic blood pressure (OR: -0.18; 95%CI: -0.32 to -0.04) at admission were the significant predictors of longer inpatient stay. Coexistent peripheral vascular disease (PVD; OR: 46.43) and congestive heart failure (CHF; OR: 30.83), and lower estimated glomerular filtration rate (eGFR; OR: 0.98) were the important predictors of mortality during the hospital treatment. The significant predictors on 30-day mortality were: Age (OR: 1.06), eGFR (0.97) and index of multiple deprivation (IMD) decile (0.74). The factors associated with long-term mortality risk were dementia (20.54-fold higher), continued use of sulfonylurea/metformin, and older age (4% higher with each additional year).

CONCLUSION

DKA carries a serious risk of mortality in both the short and long term in T2DM patients. Factors such as older age, dementia, PVD, CHF, low eGFR define the riskiest groups. These groups of patients may benefit from closer follow-up and more aggressive metabolic and comorbidity management after discharge.