Readmission rate high among diabetic ketoacidosis hospitalisations

One in five adults with type 1 diabetes who require hospital treatment for diabetic ketoacidosis are likely to return within a month and are twice as likely to die when they are readmitted, a new study has found.

A research team from Chicago used the National Readmissions Database (NRD) to study the 30-day readmission rate and the factors that influenced the second hospital visit.

Lead researcher Dr Hafeez Shaka, an internal medicine resident at John H. Stroger Jr. Hospital of Cook County in Chicago, said: “Diabetic ketoacidosis is a feared complication of type 1 diabetes because it can lead to a diabetic coma and death. But we were surprised to find that the readmission rate after diabetic ketoacidosis treatment is so high.”

They found that 91,401 diabetic ketoacidosis-related hospitalisations involved adults with type 1 diabetes who were alive at discharge from the hospital.

Women were more likely than men to be readmitted, as were people who left the hospital against medical advice during the first admission. Other risk factors for readmission included having anaemia, high blood pressure or chronic kidney disease.

Although it was unclear why women may have women may have higher rates of re-admission, for those people who left hospital against medical advice, the researchers have speculated that they may not have received the education about blood sugar control and managing other medical conditions that they would typically get at discharge.

One reason for the high overall readmission rate could be that people do not follow up with their diabetes care provider for glucose management. Individuals who experience diabetic ketoacidosis are at high risk of repeated episodes.

The patients’ subsequent admissions not only led to double the chance of in-hospital deaths compared with the first hospitalisation. The researchers also found that repeated admissions were, on average, longer and generated significantly higher health care costs.

Dr Shaka said: “Efforts should be channeled toward identifying the risk factors for readmission in hospitalised adult patients with diabetic ketoacidosis as well as ensuring proper discharge planning to decrease the burden of readmissions.”

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