Community deaths from diabetic ketoacidosis: A 14-year retrospective study in Auckland, New Zealand

To describe the demographic, clinical, and psychosocial characteristics of individuals who died from diabetic ketoacidosis (DKA) in the community.

We conducted a retrospective observational study of adults aged ≥18 years who died from DKA in the community in Auckland, New Zealand, between January 2010 and December 2023. Cases were identified through forensic pathology records, with postmortem confirmation of DKA based on vitreous glucose >10 mmol/L and beta-hydroxybutyrate (BHB) ≥2.5 mmol/L. Clinical and demographic data were obtained from electronic medical records, police and coroner's reports.

Seventy-nine individuals met inclusion criteria. Mean age was 55 ± 16 years; 61% were men. Diabetes type included type 1 (42%), type 2 (41%), pancreatogenic (2.5%), and previously undiagnosed diabetes (15%). Common features included living alone (58%), poor glycaemic control [mean HbA_1c 88 ± 25 mmol/mol (10.2 ± 4.4%)], socio-economic deprivation, clinic non-attendance, and medication non-adherence (59%). Alcohol abuse and illicit drug use were 20% and 19% respectively. Among those with known diabetes, 43% had unrecognised moderate or severe coronary artery disease at autopsy. One-third of individuals with type 1 diabetes had a DKA admission in the year prior to death, but few received timely follow-up.

Clinical factors such as living in a one-person household, poor glycaemic control, health care disengagement, and prior DKA admission may be associated with a higher risk of death by DKA in the community.