Clinical and biochemical determinants of length of stay, readmission and recurrence in patients admitted with diabetic ketoacidosis

Figures & data

Figure 1. Flow chart of the process of inclusion of patients in the study.

Table 1. Characteristics of the patients admitted with index DKA episode.

Baseline characteristics	Results (N = 922)
Age in years, median (IQR)	35 (25–45)
Males (%)	575 (62.4%)
Ethnicities, N (%)	Arabs	502 (54.4%)
	Asians	300 (32.5%)
	Africans	90 (9.7%)
	Others	30 (3.2%)
T1DM	Pre-existing	332 (36%)
	New	148 (16%)
	Total	480 (52%)
T2 DM	Pre-existing	266 (28.8%)
	New	176 (19%)
	Total	442 (47.9)
Comorbidities	Microvascular complications	95 (10.3%)
	Macrovascular complications	56 (6%)
	High metabolic risk	394 (42.7%)
HBA1c on admission, mean (SD	12.1 ± 2.7 %

Note: BMI: body mass index; DM: diabetes mellitus; T1DM: type 1 diabetes; T2DM: type 2 diabetes; COPD: chronic obstructive pulmonary disease; metabolic risk: dyslipidemia, ethnic-specific obesity, hypertension.

Figure 2. Charlson Comorbidity Index showing the comorbidity status of the study cohort.

Figure 3. Frequency of diabetes related medication use among the study cohort. (3a) Use of insulin types. (3b) Use of oral anti-diabetic medicines.

Figure 4. Reported triggering factors of DKA development during the index admission in the study cohort (iatrogenic: inadequate medication dosage prescribed, medications side-effects: DKA secondary to SGLT2 inhibitors, DDP-4 inhibitors and GLP-1 agonists).

Table 2. Clinical outcomes of patients admitted with index DKA episodes (N = 922).

Outcomes	Results
LOS in days, median (IQR)	2.6 (1.1–4.8)
DKA duration in hours, median (IQR)	18 (10.5–29)
DKA severity, N (%)
Mild	202 (21.9%)
Moderate	332 (36%)
Severe	388 (42%)
Inpatient GI bleed, N (%)	7 (0.7%)
COVID-19 infection, N (%)	11 (1.19%)
Inpatient NSTEMI, N (%)	9 (0.9%)
In-hospital mortality, N (%)	7 (0.7%)
Need for admission to MICU, N (%)	229 (24.8%)
Consult to a diabetes educator, N (%)	348 (37.7%)
DKA recurrence, N (%)
6 months	73 (7.9%)
12 Months	61 (6.6%)
90-Day all-cause readmission	140 (15.1%)

Note: DKA: diabetic ketoacidosis; LOS: length of stay; GI: gastrointestinal; COVID-19: coronavirus disease 2019; MICU: medical intensive care unit.

Table 3. Multivariate linear regression analysis model for the factors predicting length of stay.

Variable	Co-efficient	t	Significance	95% confidence interval
				Lower bound	Upper bound
CCI	0.56	2.14	0.03	0.04	1.08
Hgb at admission	−0.39	−2.84	0.005	−0.67	−0.12
Urea at admission	0.25	4.48	<0.001	0.14	0.36
Lowest sodium	−0.13	−2.58	0.01	−0.24	−0.33
Lowest potassium	−1.42	−2.23	0.02	−2.67	−0.17
Female gender	−1.93	−3.14	0.002	−3.14	−0.7
New DM	1.19	2.09	0.03	0.07	2.31
DKA duration (hours)	0.05	3.71	<0.001	0.02	0.08
MICU admission	2.59	4.6	<0.001	1.48	3.7

Notes: Corrected for age, N/L ratio, type of DM, creatinine, metabolic risks and DKA severity (N = 922). MICU: medical intensive care unit; DM: diabetes mellitus; N/L: neutrophil/lymphocyte ratio; Hgb: haemoglobin; CCI: Charlson Comorbidity Index; DKA: diabetic ketoacidosis.

Table 4. Multivariate logistic regression analysis model with predictors of 12-month recurrence. Corrected for age, length of stay and ethnicity (N = 922).

Variable	Odds ratio	95% confidence interval		Significance
		Lower bound	Upper bound
6-month recurrence	54.35	26.12	113.1	<0.001
Consult to DE	0.3	0.13	0.86	0.02
T2DM	0.3	0.10	0.85	0.02
Female gender	2.58	1.25	5.34	0.01

Note: T2DM: type 2 diabetes; DE: diabetes educators.

Data availability statement

Available from the corresponding author upon reasonable request.