Persisting mortality in diabetic ketoacidosis

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.