Disparities in Outcomes and Healthcare Utilization for Diabetic Ketoacidosis Among Patients with Type 1 and Type 2 Diabetes Mellitus: A Six-Year National Retrospective Cohort Study.

Objective: Diabetic Ketoacidosis (DKA) represents a significant burden on the healthcare system. The impact of diabetes type on DKA outcomes remains unclear. This study aims to compare mortality, length of stay (LOS), and hospital costs between patients with type 1 and type 2 diabetes mellitus (T1DM vs. T2DM) hospitalized with DKA.

Methods: We conducted a retrospective cohort study using data from the 2016-2021 National Inpatient Sample (NIS) HCUP Database, focusing on patients admitted for acute care with a diagnosis of DKA. Patients were categorized into two cohorts: T1DM vs. T2DM. The primary endpoint was mortality, assessed using multiple logistic regression. Secondary endpoints included LOS and total hospital charges, analyzed using multiple linear regression, adjusting for potential confounders. Multiple imputations accounted for missing data, and a Bonferroni correction was applied for multiple comparisons.

Results: The study included 1,244,184 patients, with 770,109 (62%) T1DM and 474,075 (38%) T2DM. Mortality was significantly higher in T2DM patients (0.91%) compared to T1DM patients (0.22%; P<0.001). LOS was longer for T2DM patients (average 3.92 days vs. 3.02 days for T1DM; P<0.001), as were hospital charges ($10,146.78 for T2DM vs. $7,811.98 for T1DM; P<0.001). Significant disparities were also observed in the demographic and hospital characteristics, including median household income, insurance type, and hospital region.

Conclusions: In this national retrospective cohort study, patients with T2DM and DKA had higher mortality rates, longer LOS, and higher healthcare costs than those with T1DM. These findings highlight critical disparities that may guide future interventions to improve DKA outcomes in T2DM patients.