DKA in older adults is common and dangerous

  • Schwarzfuchs D & al.
  • J Am Geriatr Soc
  • 5 Mar 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Diabetic ketoacidosis (DKA) increases mortality risk in older vs younger adults.

Why this matters

  • Most DKA research has been in young people with type 1 diabetes, rather than in those older and/or with type 2 diabetes.

Study design

  • Retrospective matched cohort study of 385 adults hospitalized with DKA between 2004 and 2017 at 1 Israeli medical center (
  • Funding: None.

Key results

  • The most common precipitating factors for those
  • For ≥65 years, the most common triggers were infections (sepsis, pneumonia, urinary tract).
  • Myocardial infarction and cerebrovascular accidents were more common precipitating factors for ≥65 years (7.7%) vs 
  • Serum glucose was higher in older patients (639 vs 539 mg/dL; P<.0001>
  • In-hospital mortality was higher in older (16.7%) vs younger (1.6%) patients (P<.001 as were and mortality p>
  • Hospital stays were longer in older (5 days) vs younger (3 days) patients (P<.001>
  • In 1:1 analysis matched for sex and Charlson Comorbidity Index, older vs younger patients had higher in-hospital mortality (16.7% vs 0%; P=.001) and 30-day mortality (12.1% vs 1.5%; P=.016).

Limitations

  • Retrospective.
  • Single institution.
  • No analysis by diabetes, medication types.