March 25, 2021
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Shaka H. et al. Rate and Predictor of 30-Day Readmission in Adults with Type 1 Diabetes Hospitalized in the United States for Diabetic Ketoacidosis: A Nationwide Study. Presented at: ENDO annual conference; March 20-23, 2021 (virtual meeting).
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Shaka does not report any relevant financial information.
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Adults with type 1 diabetes who are hospitalized for diabetic ketoacidosis and re-admitted within 30 days of discharge are at increased risk of inpatient mortality, according to a speaker at the ENDO annual meeting.
“About a fifth of patients with a DKA episode with type 1 diabetes are re-admitted to hospital within 30 days of discharge,” said Dr. Hafeez Shaka, an internist at John H. Stroger Jr. Hospital in Cook County, Chicago, said during a press conference. “That’s a very high number.”
About a fifth of adults hospitalized with DKA are re-admitted within 30 days of discharge, and readmission of DKA is associated with an increased risk of hospital mortality. The data are from Shaka H, et al. Rate and Predictor of 30-Day Readmission in Adults with Type 1 Diabetes Hospitalized in the United States for Diabetic Ketoacidosis: A Nationwide Study. Presented at: ENDO annual conference; March 20-23, 2021 (virtual meeting).
Shaka and colleagues reviewed data from the National Readmission Database of adults aged 18 and over with type 1 diabetes who were hospitalized for DKA from January 1 to November 30, 2017. Elective and traumatic recordings were not included in the analysis. The primary results of the analysis were the 30-day readmission rate, mortality, length of hospital stay, and total hospital costs.
There were 91,625 cases of adults with type 1 diabetes hospitalized with DKA during the study period, with 91,401 discharged. Of those discharged, 20.2% were hospitalized again within 30 days, most of them mainly for the DKA.
Adults who were re-admitted to DKA within 30 days of discharge had an increased mortality risk compared to index admission (RR = 2.06; 95% CI, 1.74-2.43; P <0.001). Admitted adults also had an increased mean hospital stay of 1 day (95% CI, 0.9-1.2; P <0.001) compared to initial admission and mean total hospital costs of $ 8,217 (95% CI, 6,940- 9,492 USD); P <0.001).
In the subgroup analysis, obesity (HR = 0.7; 95% CI, 0.62-0.79; P <0.001) and hyperlipidemia (HR = 0.92; 95% CI, 0.87-0.98; P. = 0.0007) associated with a lower risk of DKA readmission.
“Obesity appeared to be protective in this case as obesity could be a surrogate marker for patients who were traditionally more insulin compliant, as we know they need insulin to store body fat in patients with type 1 diabetes.” said Shaka. “Most of these poorly controlled patients are either underweight or within normal limits. Patients who are more compliant with their insulin tend to be more obese and suffer from a lipid disorder. “
Hypertension, chronic kidney disease, and anemia were independent predictors of DKA readmission. Women and those discharged against medical advice during their first stay in hospital were also at higher risk of readmission.
“These factors should be identified early in the year [initial] Inclusion as a means of significantly preventing readmission, which most hospitals are working on and which would also help reduce morbidity and mortality in patients with type 1 diabetes, “Shaka said.
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