medwireNews: The incidence of diabetic ketoacidosis (DKA) has risen gradually since 2004, with sharper increases occurring among the oldest and most socioeconomically deprived groups, shows an analysis of data from Scotland.
Joseph O’Reilly (University of Edinburgh, UK) and colleagues say that “the strong and widening socioeconomic disparities in DKA outcomes” are a “particular concern.”
They add: “Efforts to prevent DKA, especially in vulnerable groups, require strengthening.”
O’Reilly and team used the Scottish Care Information–Diabetes register to identify 37,939 individuals who were living with type 1 diabetes between 2004 and 2018.
During this time, 10,397 individuals experienced 30,427 DKA admissions, giving a crude event rate of 7858 cases per 100,000 person–years. There were 472 deaths that mentioned DKA, at a rate of 120 per 100,000 person–years, the majority (83.5%) of which occurred outside of a hospital admission.
The researchers report in Diabetes Care that DKA event rates increased by 5.8% per year (incidence rate ratio [IRR]=1.058) over the 14-year study period, from 6182 events per 100,000 person–years in 2004 to 8261 per 100,000 person-years in 2018. Mortality rates increased by 3.0% per year, from 95 to 204 deaths per 100,000 person–years.
Age-stratified analyses showed that DKA event rates increased in all but the 10–19-year olds. This group had the highest rates overall, but by 2018 DKA incidence had fallen to a level that was similar to that in 20–29-year olds (the second highest group).
The largest increase occurred among people aged 60 years and older (IRR=1.096), which O’Reilly et al say is “concerning” because this group also had the highest case-fatality rates.
The researchers also observed large differences by socioeconomic status, with individuals in the least deprived quintile a significant 55% less likely to experience DKA than those in the most deprived quintile.
Furthermore, this association remained after adjustment for glycated hemoglobin (HbA1c) levels and the use of insulin pumps, both of which were also associated with DKA rates.
Specifically, higher HbA1c was associated with significantly higher DKA rates, while the use of insulin pumps, as well as completion of a structured diabetes education course, were associated with significantly lower DKA incidence.
Other significant associations were found for sex, with men experiencing lower DKA incidence than women (IRR=0.814), and antidepressant and methadone use, which were both associated with higher DKA rates (IRR=1.474 and 1.468, respectively).
Of note, despite the lower DKA incidence, men had a significantly higher case fatality rate than women.
O’Reilly et al conclude that prevention of DKA “should remain a priority, particularly as DKA rates are rising.”
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