Temporal Trends in the Prevalence of Diabetes Decompensation (Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State) Among Adult Patients Hospitalized with Diabetes Mellitus: A Nationwide Analysis Stratified by Age, Gender, and Race

Desai, Rupak; Singh, Sandeep; Mh, Syed; Dave, Hitanshu; Hasnain, Mehrul; Zahid, Daniyal; Haider, Mohammad Zeeshan; Sma, Jilani; Ma, Mirza; Kiran, N. Udaya; Aziz, Alfred

doi:10.7759/cureus.4353

Cited by 17 publications

(18 citation statements)

References 29 publications

(40 reference statements)

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“…The prevalence of DKA in patients with diabetes in our cohort was substantially higher than the 0.9% prevalence of hyperglycemic emergency (encompassing DKA, and the related hyperosmolar hyperglycemic state) in patients hospitalized for all causes in National Inpatient Sample (NIS) datasets [14] . Patients with diabetes who developed DKA were younger (64 vs. 69 years old), had higher levels of HbA1c, and had fewer chronic medical conditions (14% with CKD, 63.7% with HTN and 10.8% with pulmonary disease, as compared to 22.8%, 84% and 19.8% respectively) as compared to patients with diabetes and without DKA.…”

Section: Discussioncontrasting

confidence: 54%

Diabetic ketoacidosis and mortality in COVID-19 infection

Stevens

Bogun

McMahon

et al. 2021

Diabetes & Metabolism

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Aim - Patients with diabetes have increased morbidity and mortality from COVID-19. Case reports describe patients with simultaneous COVID-19 and diabetic acidosis (DKA), however there is limited data on the prevalence, predictors and outcomes of DKA in these patients. Methods - Patients with COVID-19 were identified from the electronic medical record. DKA was defined by standardized criteria. Proportional hazard regression models were used to determine risk factors for, and mortality from DKA in COVID-19. Results - Of 2366 patients admitted for COVID-19, 157 (6.6%) patients developed DKA, 94% of whom had antecedent type 2 diabetes, 0.6% had antecedent type 1 diabetes, and 5.7% patients had no prior diagnosis of diabetes. Patients with DKA had increased hospital length of stay and in-patient mortality. Higher HbA1c predicted increased risk of incident DKA (HR 1.47 per 1% increase, 95% CI 1.40-1.54). Risk factors for mortality included older age (HR 1.07 per 5 years, 95% CI 1.06 - 1.08) and need for pressors (HR 2.33, 95% CI 1.82-2.98). Glucocorticoid use was protective in patients with and without DKA. Conclusion - The combination of DKA and COVID-19 is associated with greater mortality, driven by older age and COVID-19 severity.

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Section: Discussioncontrasting

confidence: 54%

Diabetic ketoacidosis and mortality in COVID-19 infection

Stevens

Bogun

McMahon

et al. 2021

Diabetes & Metabolism

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“…Although smoking remains a widely reported CVD risk factor for worse outcomes, it did not play a role in predicting short-term outcomes for frail patients in our study. The rising burden of endocrine disorders, including diabetes mellitus and hypothyroidism among the US population, is known to play a role in PCI outcomes [19]. However, in our study, we did not observe a correlation between diabetes or hypothyroidism and in-hospital negative outcomes in frail patients.…”

Section: Discussioncontrasting

confidence: 89%

Outcomes and Predictors of Mortality in Hospitalized Frail Patients Undergoing Percutaneous Coronary Intervention

Desai

Amraotkar

et al. 2019

Cureus

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To study the impact of frailty on inpatient outcomes among patients undergoing percutaneous coronary intervention (PCI). Methods The National Inpatient Sample data of all PCI-related hospitalizations throughout the United States (US) from 2010 through 2014 was utilized. Patients were divided into two groups: frailty and no-frailty. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes were used to stratify groups and outcomes. In order to address the substantial difference in the total number of valid observations between the two groups, a propensity-matched analysis was performed at a 1:1 ratio and caliper width of 0.01.

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“…HHS is recognized as an emerging issue in children and young adults (14). Other studies using NIS have found similar increases in hyperglycemic crisis events but use different denominators (15,16). Our study is unique in that we report rates by the population with diagnosed diabetes, which accounts for changes in diabetes epidemiology over time.…”

Section: Discussionmentioning

confidence: 92%