Characteristics, Risk Factors, and Outcome of Recurrent Diabetic Ketoacidosis in Adults

Abstract To assess the clinical characteristics of patients hospitalized with recurrent diabetic ketoacidosis (DKA). We examined the database for patients admitted with recurrent DKA (more than one admission) to government hospitals in Qatar over 6 years and compared them to patients with a single admission. A total of 1,612 patients with DKA were evaluated, of whom 434 patients (26.9%) had recurrent DKA. Compared with patients who had a single admission for DKA, those with recurrent DKA were younger (35.0 [24.0–53.0] vs. 39.0 [28.0–54.0] years, p < 0.001), more likely to be females (50.6 vs. 37.1%, p < 0.001), had a longer duration of diabetes (12.0 [5.0–19.0] vs. 5.0 [0.0–13.0] years, p < 0.001), more likely to have severe DKA (48.6 vs. 38%, p < 0.001), and had shorter time to resolution of DKA (12.5 [9.0–24.0] vs. 23.0 [10.0–33.0] hours, p < 0.001). There was no difference in the precipitating cause of DKA, need for admission to the intensive care unit, hospital stay, or inpatient mortality. On multivariable logistic regression analysis, significant predictors of recurrent DKA were younger age (odds ratio, 0.96; 95% confidence interval [CI]: 0.95–0.98; p = 0.0001), female gender (odds ratio, 0.63; 95% CI: 0.46–0.85; p = 0.003), and longer duration of diabetes (odds ratio, 1.07; 95% CI: 1.04–1.09, p = 0.0001). In this national cohort of patients, recurrent DKA was associated with younger age, female predominance, and longer duration of diabetes, but no difference in duration of hospital stay and inpatient mortality compared with patients with a single admission for DKA.