Health Care Utilization and Burden of Diabetic Ketoacidosis over the Last Decade: A Nationwide Analysis

Presentation Number: SH02-1
Date of Presentation: April 2nd, 2017

Dimpi Desai*1, Dhruv Mehta2 and Ulrich K Schubart3
1Jacobi Medical Center & Albert Einstein College of Medicine, Bronx, NY, 2Westchester Medical Center and New York Medical College, Valhalla, NY, 3Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY


Diabetes mellitus is one of the most common chronic diseases and is a leading cause of morbidity and mortality in the United States. Although our ability to treat diabetes and its associated complications has significantly improved, presentation with uncontrolled diabetes leading to ketoacidosis remain a significant problem. We aim to determine the incidence and costs of hospital admission associated with diabetic ketoacidosis (DKA). We reviewed the National Inpatient Sample Database (NIS) for all hospitalizations in which DKA (250.10, 250.11, 250.12, and 250.13) was the principal discharge diagnosis during the period from 2003-2013 and calculated the population incidence using US Census data. Patients with ICD 9 codes for diabetic coma were excluded because they do not distinguish between hypoglycemic and DKA related coma. We then analyzed changes in temporal trends of incidence, length of stay, costs and in-hospital mortality utilizing Cochrane-Armitage test.There were 1,571,136 primary admissions for DKA during the study period. In-hospital mortality for the cohort was 0.4% (n=6411). The population incidence increased significantly from 409.5 cases/million in 2003 to 577.3 cases/million in 2013 (P<0.01). The length of stay significantly decreased from an average of 3.64 days in 2003 to 3.23 days in 2013 (P<0.01). During this period, the mean hospital charges increased significantly from $18,553 (after adjusting for inflation) per admission in 2003 to $25,416 per admission in 2013.The resulting aggregate charges (i.e., “national bill”) for diabetes with ketoacidosis increased dramatically, from $2.2 billion (after adjusting for inflation) in 2003 to $ 4.6 billion in 2013 (p<0.001). However, there was a significant reduction in mortality over a period of 11 years from 611 (0.51%) in 2003 to 595 (0.3%) in 2013 (P<0.01). Our analysis shows that the population incidence for DKA hospitalizations in the USA continues to increase. Reasons for this increase need to be explored in detail. Strategies to reverse this trend need to be developed. Somewhat reassuringly, the mortality of this condition has significantly decreased, indicating advances in early diagnosis and better in-hospital care. Despite decrease in the length of stay, the costs of hospitalizations have increased significantly, indicating opportunities for value based care intervention in this vulnerable population


Nothing to Disclose: DD, DM, UKS