medwireNews: More than one in five patients with Type 1 diabetes and recurrent hospital admissions for diabetic ketoacidosis (DKA) die within a few years of an admission, research shows.
And, although older than survivors, the patients who died were young. The median age of the 44 patients who died was 43 years, compared with 28 years for the 254 who survived.
All patients in the study had Type 1 diabetes and had been admitted at least once for DKA to the Royal Infirmary of Edinburgh between 2007 and 2012.
Despite recent evidence of “suboptimal adherence to DKA management protocols in the UK”, just one (0.16%) patient died in hospital, report Fraser Gibb (Royal Infirmary of Edinburgh, UK) and study co-authors.
“However, the frequency of subsequent sudden death at home, particularly in young people, is unacceptably high”, they write in Diabetologia.
The overall mortality rate during a median 4.9 years after discharge was 14.8%, but was 10.6% in patients with a single DKA admission over the 6-year study period, rising to 18.3% in those with two to four admissions and 29.6% in those with five or more. Patients who had just one DKA admission in their lifetime had a 5.2% mortality rate over a median 4.1 years of follow-up, rising to 23.4% over 2.4 years for those with five or more admissions.
Twenty-three of the deaths occurred at home, among patients aged a median of 38 years, compared with 57.7 years among patients who died in hospital. Nineteen deaths had no determined cause but were “potentially attributable to acute metabolic decompensation”, and the median age of these patients was just 31 years. Ten deaths, including eight that occurred at home, happened within 2 months after the most recent DKA episode.
Recurrent DKA admissions predicted mortality on multivariate analysis, as did older age, longer duration of diabetes and previous inpatient stays for psychiatric illnesses.
Patients with recurrent DKA admissions, which is a feature of “brittle diabetes” (as opposed to stable diabetes), had higher glycated haemoglobin levels than those without (11.6 vs 9.4%) and were more socially deprived.
“Longitudinal studies of ‘brittle diabetes’ suggest that patients eventually cease presenting with recurrent DKA, anecdotally often following positive life events, but frequently develop a significant burden of chronic diabetes complications”, say the researchers.
“Considerable challenges remain in preventing early death and later complications in this vulnerable group.”
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