Clinical and socio‐demographic factors associated with diabetic ketoacidosis hospitalization in adults with Type 1 diabetes

Abstract

To identify the clinical and socio-demographic factors associated with hospitalization for diabetic ketoacidosis in adults with Type 1 diabetes. We combined clinical and administrative health data from a large urban diabetes clinic to perform a data linkage study. We identified adults (aged ≥ 18 years old) with Type 1 diabetes and linked to hospital discharge abstracts to assess for diabetic ketoacidosis hospitalization. The study period was between 1 January 2004 and 31 December 2009, with all individuals living in the same geographic area. Multivariate logistic regression was used to identify potential predictors of diabetic ketoacidosis hospitalization. We identified 255 individuals with a diabetic ketoacidosis hospitalization and 1739 without a diabetic ketoacidosis hospitalization. Mean (standard deviation) age was 40.0 (15.8) years, 51.7% were men and mean duration of diabetes was 17.8 (12.9) years. Diabetic ketoacidosis hospitalization was associated with shorter duration of diabetes (odds ratio 0.96 per year; 95% confidence interval 0.95-0.98), gastroparesis (odds ratio 4.13; 95% confidence interval 1.82-9.35), psychiatric diagnosis (odds ratio 1.98; 95% confidence interval 1.22-3.19), and higher HbA1c (odds ratio 1.25 per 1% increase; 95% confidence interval 1.16-1.35). This study identifies specific clinical factors associated with diabetic ketoacidosis hospitalization in adults with Type 1 diabetes. This information can help to inform the detection of high-risk patients, for whom special attention and interventions may be warranted to prevent diabetic ketoacidosis.