2019 issues

Decompensated Diabetes More Common in Certain Racial, Age Groups

by U.S. Medicine

August 22, 2019

ATLANTA—Which diabetes patients are most likely to have decompensated diabetes, defined as diabetic ketoacidosis and hyperosmolar hyperglycemic state?

A study published in Cureus sought to determine that across age, gender and racial groups of hospitalized patients with diabetes.

The Atlanta VAMC-led study used the National Inpatient Sample (NIS) datasets (2007-2014) to assess the prevalence and temporal trends in decompensated diabetes, stratified by age, gender and race and related in-hospital outcomes among the adult patients hospitalized with diabetes using International Classification of Diseases, Ninth Revision,Clinical Modification (ICD-9-CM) codes. Discharge weights were used to obtain national estimates.

Of 56.7 million hospitalizations with diabetes, 0.5 (0.9%) were diagnosed with decompensated diabetes from 2007 to 2014. Researchers determined that the decompensated diabetics tended to be of younger (~52 vs. 66 yrs) and more often black (24.2% vs. 17.3%) and Hispanic (12.9% vs. 10.9%) patients as compared to those without decompensation (p<0.001).

While younger diabetes patients demonstrated the highest prevalence of in-hospital decompensation (18-44 yrs; 3.7%) with a relative increase of 32.4% (from 3.4% to 4.5%) from 2007 to 2014 (ptrend<0.001), diabetes patients 65 and older with decompensation suffered the highest in-hospital mortality (12.8%), according to the report.

“The overall rate of decompensation was similar (0.9%) among male and female diabetes patients. However, over a period of eight years, the rates of decompensation rose to 1.1% (ptrend<0.001) in males and 1.2% (ptrend<0.001) in females, respectively,” the authors wrote.

The study noted that all-cause in-hospital mortality among females with decompensated diabetes declined from 6.6% in 2007 to 5.9% in 2014 (ptrend=0.019), but there was no significant drop in in-hospital mortality among male diabetics with acute decompensation (6.7% in 2007 to 6.8% in 2014, ptrend=0.811) during that time period.

In addition, researchers said they observed significantly increasing trends in decompensated diabetes among all racial groups between 2007 and 2014 (ptrend<0.001), with in-hospital mortality highest among Asian or Pacific Islander (0.9%) diabetes patients with decompensation from 2007 to 2014. Inpatient mortality trended down among Asian or Pacific Islander (ptrend=0.029) and Hispanic (ptrend<0.001) patients with decompensated diabetes, but other race groups did not observe any significant decline in mortality over the study period, they said.

Compared with patients without decompensation, diabetes hospitalizations with decompensation demonstrated significantly higher:

  • In-hospital mortality (6.3% vs. 2.6%; p<0.001), 
  • Average length of stay (7.7 vs. 5.4 days; p<0.001), 
  • Hospital charges ($65,904 vs. $42,889, p<0.001), and 
  • More frequent transfers to short-term hospitals (3.9% vs. 2.9%; p<0.001).

Also substantially higher with decompensation were rates of acute myocardial infarction (AMI) (10.4% vs. 4.8%; p<0.001), stroke (4.0% vs. 3.3%; p<0.001) and venous thromboembolism (3.5% vs. 2.6%; p<0.001).

“There was an increasing trend in the prevalence of decompensated diabetes from 2007 to 2014, most remarkable among younger black male diabetics,” study authors concluded. “The patients with decompensated diabetes suffered higher in-hospital mortality and rates of AMI, stroke and venous thromboembolism, there was no significant decline in the mortality between 2007 and 2014.”

1. Desai R, Singh S, Syed MH, Dave H, et. Al. Temporal Trends in the Prevalence of Diabetes Decompensation (Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State) Among Adult Patients Hospitalized with Diabetes Mellitus: A Nationwide Analysis Stratified by Age, Gender, and Race. Cureus. 2019 Apr 1;11(4):e4353. doi: 10.7759/cureus.4353. PubMed PMID: 31192058; PubMed Central PMCID: PMC6550510.

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