(2.16) Disparities in Outcomes and Healthcare Utilization for Diabetic Ketoacidosis Among Patients with Type 1 and Type 2 Diabetes Mellitus: A Five-Year National Retrospective Cohort Study
Endocrinology Fellow St. Louis University Hospital SAINT LOUIS, Missouri, United States
Objective : Diabetic Ketoacidosis (DKA) presents a critical healthcare challenge, with outcomes and resource utilization significantly influenced by the type of Diabetes Mellitus (DM): type 1 (T1DM) and type 2 (T2DM). This study aimed to compare the impact of these DM types on mortality, length of stay (LOS), and hospital charges.
Methods: We conducted a retrospective cohort study utilizing the 2016-2020 National Inpatient Sample (NIS) HCUP Database with adult patients admitted to acute care. We divided patients into two cohorts, those with type 1 vs type DM. The primary endpoint was mortality obtained with multiple logistic regression analysis. Secondary endpoints included LOS and total hospital charges assessed with multiple linear regression analysis. We accounted for missing data with multiple imputation analyses. We addressed multiplicity utilizing statistical significance adjusted with Bonferroni-corrected alpha value.
Results: The study revealed significant differences in mortality, with T2DM patients having a higher mortality rate (0.85%) than T1DM patients (0.2%; P< 0.001). T2DM patients also experienced longer LOS (average: 3.81 days vs. 2.97 days for T1DM, P< 0.001) and incurred higher hospital charges (average: $40,433 vs. $29,873 for T1DM, P< 0.001). Significant disparities were observed in the median household income, insurance type, hospital region, bed size, for-profit status, and teaching hospital status. Additional conditions such as Afib, CAD, CHF, HTN, obesity, hyperlipidemia, CVA, COPD, ESRD, cirrhosis, MI, vascular complications, AKI requiring HD, and the need for mechanical ventilation showed varying prevalence between the groups, with T2DM patients generally having higher rates of these conditions.
Discussion/Conclusion: This retrospective study revealed that patients with DKA and type 1 DM have a lower mortality compared to those with Type 2 DM. These findings suggest the need for targeted healthcare strategies to address these disparities and improve patient outcomes, emphasizing the importance of personalized care approaches tailored to the specific needs of patients with different types of diabetes.
