Social and Metabolic Characteristics Associated With Multiple DKA Admissions at a Large County Hospital

Area of Science:

• Endocrinology
• Public Health
• Addiction Medicine

Background:

• Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes mellitus (T1DM).
• Recurrent DKA admissions pose a significant burden on healthcare systems and patients.
• Social determinants of health may influence DKA recurrence.

Purpose of the Study:

• To identify social factors differentiating T1DM patients with single versus multiple DKA admissions.
• To explore the association between substance use and DKA recurrence in an urban, safety-net hospital setting.

Main Methods:

• Retrospective analysis of electronic health records for T1DM patients admitted for DKA (2019-2021).
• Collection and statistical analysis of laboratory values, demographics, and social histories.
• Logistic regression was used to identify predictors of multiple DKA admissions.

Main Results:

• No significant differences were found in laboratory values, length of stay, or socioeconomic factors between single and multiple DKA admission groups.
• Patients with multiple DKA admissions exhibited higher rates of substance use disorder (60.9% vs 33.0%), particularly cannabis, tobacco, and psychoactive substances.
• Substance use, including any substance use (OR 3.17) and cannabis use (OR 3.70), significantly increased the risk of multiple DKA admissions.

Conclusions:

• Substance use is a potential predictor for T1DM patients at risk of recurrent DKA.
• Identifying patients with substance use may allow for targeted interventions to decrease DKA recurrence.
• Findings are relevant for similar community hospital populations managing T1DM patients.