SAT-644 Type 1 vs Type 2 Diabetes in DKA: A Comparative Analysis of Cardiac Complications

Abstract Disclosure: S. Prasad: None. M. Souleymane: None. S. Balasubramanian: None. M. Singh: None. S. Ball: None. A. Jala: None. A. Faizal: None. R. Viswanathan: None. M.F. Akhter: None. R. Patel: None. D. Thor: None. M. Lee: None. Y. Wang: None. Introduction: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus (DM) with significant cardiovascular risks. While mortality is higher in DKA associated with type 2 diabetes (DM II), the comparative burden of cardiac complications between type 1 diabetes (DM I) and DM II remains unclear. Given the younger age and lower prevalence of traditional cardiovascular risk factors in the DM I population, understanding the differential impact of DKA on cardiac outcomes is crucial. Objective: To compare mortality and cardiac complications in DKA patients with DM I versus DM II using the National Inpatient Sample(NIS) database. Methods: A retrospective study of the NIS from 2018-2022 identified DKA hospitalizations in adults (≥18 years) using ICD-10 codes. Patients were categorized by DM type. Outcomes included mortality, acute coronary syndrome (ACS), heart failure exacerbations, arrhythmias, cardiac arrest, and other cardiac complications. Multivariate logistic regression was performed to calculate adjusted odds ratios (aOR), adjusting for demographics and comorbidities. Results: Among 1,141,960 DKA hospitalizations, 58.8% had DM I and 41.2% had DM II. DM I patients were younger (31.2 vs. 51.3 years), more often white (59.6% vs. 44.7%), and more frequently female (49.7% vs. 44.7%)(p<0.05 for all comparisons). DM II patients had higher Charlson Comorbidity Index scores (2.27 vs. 1.82), CAD prevalence (12.0% vs. 5.0%), obesity (23.4% vs. 6.1%), and hypertension (44.6% vs. 20.7%)(p<0.005 for all comparisons).Mortality was higher in DM II (0.90% vs. 0.22%, aOR 1.71, p<0.005). However, DM I patients had greater odds of ACS (aOR 1.34, p<0.005) and pericardial effusion (aOR 1.38, p<0.005). No differences were noted in atrial or ventricular arrhythmias, cardiac arrest, acute heart failure, or cardiogenic shock. DM II admissions had higher costs ($43,698 vs. $32,522, p<0.005) and longer length of stay (3.9 vs. 2.9 days, p<0.005). Conclusion: Although mortality was higher in DM II, cardiac complications, particularly ACS and pericardial effusion, were more frequent in DM I, despite younger age and fewer comorbidities. This suggests that DKA in DM I poses distinct cardiovascular risks beyond conventional risk factors, necessitating heightened monitoring. Further research is needed to explore the underlying mechanisms and improve management strategies for both groups. Presentation: Saturday, July 12, 2025