Healthcare Resource Use and Mortality After Diabetic Ketoacidosis: Insights From Linked Primary- and Secondary-Care Data in the UK
Author(s)
Samuel Seidu, MD1, Clare Hambling, MD2, Ramzi Ajjan, MD3, Bethany Levick, PhD4, Shea O'Connell, PhD5, Christopher Chesters, PhD6, Fleur Levrat Guillen, PharmD7, Pratik? Choudhary, MD1.
1University of Leicester, Leicester, United Kingdom, 2Primary Care Diabetes & Obesity Society (PCDOS), London, United Kingdom, 3University of Leeds, Leeds, United Kingdom, 4OPEN Health Evidence & Access, Marlow, United Kingdom, 5OPEN Health, Edinburgh, United Kingdom, 6Global Outcomes Research Manager, Abbott, Maidenhead, United Kingdom, 7Abbott diabetes care, London, United Kingdom.
1University of Leicester, Leicester, United Kingdom, 2Primary Care Diabetes & Obesity Society (PCDOS), London, United Kingdom, 3University of Leeds, Leeds, United Kingdom, 4OPEN Health Evidence & Access, Marlow, United Kingdom, 5OPEN Health, Edinburgh, United Kingdom, 6Global Outcomes Research Manager, Abbott, Maidenhead, United Kingdom, 7Abbott diabetes care, London, United Kingdom.
OBJECTIVES: To describe mortality and hospital resource use following diabetic ketoacidosis (DKA) among type 1 (T1DM) or type 2 diabetes (T2DM) using snapshot cohorts from 2019 (pre-pandemic) and 2022 (post-pandemic).
METHODS: This retrospective cohort study used Clinical Practice Research Datalink (CPRD) Aurum/Gold data linked to Hospital Episode Statistics and ONS mortality data. Adults aged ≥18 years hospitalised for DKA in 2019 or 2022 were included. Outcomes included 30-day all-cause mortality, all-cause mortality to 31 March 2023 (latest linked mortality data available), inpatient length of stay (LOS), 30-day all-cause readmission following DKA, and DKA recurrence within 12 months. Cohorts were comparable by age and sex, with consistent ICD-10 criteria applied across years.
RESULTS: In 2019, 1,655 people with T1DM and 962 with T2DM had DKA admissions, compared with 1,003 and 1,111 in 2022. Thirty-day mortality was 1.8% and 3.7% in T1DM and 11.0% and 13.1% in T2DM, in 2019 and 2022 respectively. By March 2023, mortality reached 19.8% (T1DM) and 49.0% (T2DM) in the 2019 cohort (up to 4 years’ follow-up), and 13.5% and 32.3% in 2022 (up to 1 year). Median LOS in T1DM was 3.0 days in 2019 and 4.0 days in 2022. In T2DM, median LOS was 8.0 and 9.0 days, respectively. Thirty-day readmission occurred in 15.7% of T1DM and 21.7% of T2DM patients in 2019, and in 13.9% and 16.4%, respectively, in 2022. Recurrent DKA within 12 months (≥2 DKAs) was recorded in 25.1% of T1DM and 9.8% of T2DM patients in 2019, and in 22.2% and 8.4%, respectively, in 2022.
CONCLUSIONS: DKA is a potent marker of vulnerability, associated with substantial mortality, recurrence and readmission. Recurrent events are particularly common in T1DM, while mortality remains disproportionately high in T2DM. These data support the urgent need for tailored discharge protocols and real-time monitoring strategies, especially in older, comorbid patients with T2DM.
METHODS: This retrospective cohort study used Clinical Practice Research Datalink (CPRD) Aurum/Gold data linked to Hospital Episode Statistics and ONS mortality data. Adults aged ≥18 years hospitalised for DKA in 2019 or 2022 were included. Outcomes included 30-day all-cause mortality, all-cause mortality to 31 March 2023 (latest linked mortality data available), inpatient length of stay (LOS), 30-day all-cause readmission following DKA, and DKA recurrence within 12 months. Cohorts were comparable by age and sex, with consistent ICD-10 criteria applied across years.
RESULTS: In 2019, 1,655 people with T1DM and 962 with T2DM had DKA admissions, compared with 1,003 and 1,111 in 2022. Thirty-day mortality was 1.8% and 3.7% in T1DM and 11.0% and 13.1% in T2DM, in 2019 and 2022 respectively. By March 2023, mortality reached 19.8% (T1DM) and 49.0% (T2DM) in the 2019 cohort (up to 4 years’ follow-up), and 13.5% and 32.3% in 2022 (up to 1 year). Median LOS in T1DM was 3.0 days in 2019 and 4.0 days in 2022. In T2DM, median LOS was 8.0 and 9.0 days, respectively. Thirty-day readmission occurred in 15.7% of T1DM and 21.7% of T2DM patients in 2019, and in 13.9% and 16.4%, respectively, in 2022. Recurrent DKA within 12 months (≥2 DKAs) was recorded in 25.1% of T1DM and 9.8% of T2DM patients in 2019, and in 22.2% and 8.4%, respectively, in 2022.
CONCLUSIONS: DKA is a potent marker of vulnerability, associated with substantial mortality, recurrence and readmission. Recurrent events are particularly common in T1DM, while mortality remains disproportionately high in T2DM. These data support the urgent need for tailored discharge protocols and real-time monitoring strategies, especially in older, comorbid patients with T2DM.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
RWD92
Topic
Clinical Outcomes, Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity), No Additional Disease & Conditions/Specialized Treatment Areas