Sebastian Breivik Soleim

Aims: To describe trends in diabetic ketoacidosis admissions and examine factors associated with repeated admissions and mortality among adults living with type 1 diabetes. Materials and methods: Diabetic ketoacidosis admissions among adults at a Norwegian university hospital between 1 August 2012 and 31 August 2022 were retrospectively reviewed using electronic medical records. Results: A total of 178 participants with 306 admissions were included. Median [IQR] age at admission was 34 years [22–51]. Median HbA1c was 88 mmol/mol [72–105]. Diabetic ketoacidosis admission frequency decreased by an estimated 6.9% annually (RR 0.931; 95% CI 0.896–0.968; p < 0.001) over the 10-year period. 40 participants (22.5%) had more than one admission during the study period. Psychiatric illness (aOR 2.827; 95% CI 1.070–7.468; p = 0.036) and receipt of disability benefits (aOR 4.941; 95% CI 1.576–15.490; p = 0.006) were associated with experiencing more than one lifetime admission. Prior diabetic ketoacidosis, suspected treatment non-adherence and psychiatric illness were associated with higher readmission rates during follow-up. In-hospital mortality was 1.6%, and 5-year cumulative mortality was 14.7%. Alcohol or substance misuse (HR 2.499; 95% CI: 1.191–5.245; p = 0.015) and higher age at the index admission (HR 1.874; 95% CI: 1.511–2.324; p < 0.001, per 10 years) were associated with mortality in the follow-up period. Conclusions: Diabetic ketoacidosis admissions declined substantially over the 10-year study period despite growth in the hospital catchment area population, suggesting that diabetes care has improved. Repeated admissions were common and associated with psychosocial vulnerability. In-hospital mortality was low, but five-year mortality was considerable, supporting targeted follow-up after an episode of diabetic ketoacidosis.