Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
Department of Internal Medicine, Samaritan Medical Center, Watertown, New York, USA.
J Investig Med. 2021 Aug;69(6):1196-1200. doi: 10.1136/jim-2021-001901. Epub 2021 May 10.
Diabetic ketoacidosis (DKA) is a known complication of patients with type 1 diabetes mellitus (T1DM), but less common in type 2 diabetes mellitus (T2DM). The aim of this study was to compare the outcomes of patients admitted to the hospital with DKA in T1DM versus T2DM. This was a population-based, retrospective, cohort study using data from the Nationwide Inpatient Sample. The group of patients hospitalized for DKA was divided based on a secondary diagnosis of either T1DM or T2DM. The primary outcome was inpatient mortality, and the secondary outcomes were rate of complications, length of hospital stay (LOS) and total hospital charge (THC). The inpatient mortality for DKA was 0.27% (650 patients). In T2DM, the adjusted OR (aOR) for mortality was 2.13 (95% CI 1.38 to 3.28, p=0.001) with adjusted increase in mean THC of $6035 (95% CI 4420 to 7652, p<0.001) and mean LOS of 0.5 day (95% CI 0.3 to 0.6, p<0.001) compared with T1DM. Patients with T2DM had significantly higher odds of having septic shock (aOR 2.02, 95% CI 1.160 to 3.524, p=0.013) compared with T1DM. T2DM was associated with higher inpatient mortality, septic shock and increase in healthcare utilization costs compared with T1DM.
糖尿病酮症酸中毒（DKA）是 1 型糖尿病（T1DM）患者的已知并发症，但在 2 型糖尿病（T2DM）中较少见。本研究旨在比较 T1DM 和 T2DM 患者因 DKA 住院的结局。这是一项基于人群的回顾性队列研究，使用来自全国住院患者样本的数据。根据 T1DM 或 T2DM 的次要诊断，将住院治疗 DKA 的患者分为两组。主要结局是住院死亡率，次要结局是并发症发生率、住院时间（LOS）和总住院费用（THC）。DKA 的住院死亡率为 0.27%（650 例）。在 T2DM 中，死亡的调整比值比（aOR）为 2.13（95%置信区间 1.38 至 3.28，p=0.001），调整后的平均 THC 增加了 6035 美元（95%置信区间 4420 至 7652，p<0.001），平均 LOS 增加了 0.5 天（95%置信区间 0.3 至 0.6，p<0.001）与 T1DM 相比。与 T1DM 相比，T2DM 患者发生感染性休克的几率显著更高（aOR 2.02，95%置信区间 1.160 至 3.524，p=0.013）。与 T1DM 相比，T2DM 与更高的住院死亡率、感染性休克和医疗保健利用成本增加相关。
