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Persisting mortality in diabetic ketoacidosis
Insights
Hospital mortality for diabetic ketoacidosis remains stable at 3.9% over 21 years. While deaths in younger patients decreased, further reductions in diabetic ketoacidosis mortality may be challenging due to comorbidities.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Internal Medicine
Background:
- Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus.
- Hospital mortality rates for DKA have historically been a concern.
- Understanding trends in DKA mortality is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze the hospital mortality rate of diabetic ketoacidosis over a 21-year period.
- To identify changes in mortality trends and causes of death over time.
- To assess the potential for further reduction in DKA-related mortality.
Main Methods:
- Retrospective analysis of 929 DKA episodes treated at a single center over 21 years.
- Comparison of mortality rates and causes of death between the first and second halves of the study period.
- Stratification of deaths by age and presence of concurrent illnesses.
Main Results:
- Overall hospital mortality for DKA was 3.9%.
- No significant difference in mortality was observed between the first half (4.4%) and the second half (3.4%) of the study.
- Deaths in patients under 50 significantly decreased in the second half, but deaths from metabolic causes did not significantly change.
- Remaining deaths were primarily due to concurrent illnesses like myocardial infarction and infections, particularly in elderly patients.
Conclusions:
- Hospital mortality for diabetic ketoacidosis has remained relatively stable over the past two decades.
- While DKA management has improved, leading to fewer deaths in younger individuals, further significant reductions in overall mortality may be limited.
- Concurrent medical conditions, especially in older patients, represent a major challenge in reducing DKA mortality further.
Abstract:
An overall hospital mortality rate of 3.9% was found in 929 episodes of diabetic ketoacidosis treated in single centre over a 21-year period. The mortality rate in the first half of the survey (4.4%) was not significantly different from that in the second half of the survey (3.4%). Six deaths in patients under 50 years of age occurred in the first half, but only one death under 50 years occurred in the second half of the survey. The number of deaths from a metabolic cause where no other illness was identified also fell from nine (43% of deaths) in the first half to five (33% of deaths) in the second half of the study (not significant). The remaining deaths were due to concurrent illness, mainly myocardial infarction and serious infections. Many of the residual deaths occurred in elderly patients with such medical illness in addition to the ketoacidosis. It may, therefore, prove difficult to reduce mortality further in diabetic ketoacidosis.