Diabetic ketoacidosis (DKA) in Birmingham, UK, 2000—2009: an evaluation of risk factors for recurrence and mortality

Abstract

D iabetic ketoacidosis (DKA) is an acute metabolic complication of type 1 diabetes mellitus. This study aimed to define the DKA mortality rate in a Birmingham population and to identify risk factors for mortality and repeat admissions. An evaluation of 137 patients' notes retrieved from five hospitals in and around Birmingham, UK, identified 278 admissions over a 9-year period (2000-2009). The International Classification of Disease 10 coding system for DKA, E101, was employed to identify notes. Overall five (1.8%) patients died. Mortality was significantly associated with age, presence of comorbidity and diabetic complications. Poor control and compliance, female sex, clinic non-attendance, presence of co-morbidity and psychological problems all increased the risk of recurrent DKA admissions. Our study supports a role for improving education and glycaemic control to reduce DKA and its associated mortality. Br J Diabetes Vasc Dis 2009;9:278-282

Diabetic ketoacidosis in type 2 diabetes mellitus

“…It is a life‐threatening condition with reported mortality rates in patients with type 1 diabetes of 2% in the United Kingdom and 2–5% in the USA . However, prompt recognition and management can result in full recovery.…”

Risk factors for recurrent admissions with diabetic ketoacidosis: a case–control observational study

“…Infections, such as urinary tract infection or pneumonia, are also common causes of DKA . Other identified risks for recurrent admission with DKA include clinic non‐attendance, non‐compliance with insulin treatment, psychiatric comorbidity, socio‐economic status and cocaine use .…”

National survey of the management of Diabetic Ketoacidosis (DKA) in the UK in 2014

“…Thus we have no way of linking to the UK National Diabetes Audit and so correlate the current data with frequency of previous admissions, hospital clinic attendance rates, previous HbA1c, socioeconomic data, or the presence of other co-morbidities. Previous work has shown that poor glycaemic control and frequent clinic non-attendance, female gender, the presence of psychological problems and comorbidities all increased the risk of DKA [12,34]. Other factors reported in the US included low household income, having a low education, and having no health insurance [34].…”

“…More recently, some authors have suggested that with improvements in overall care, deaths from hyperglycaemic crisis and DKA have been declining [13], but it remains a condition with a significant mortality in adults of between 0.7 and 5% [12,14,15].…”