Among adults, two-thirds of episodes of diabetic ketoacidosis (DKA) occur in people diagnosed with type 1 diabetes, while one third occur in those with type 2 diabetes.[9]Dhatariya KK, Glaser NS, Codner E, et al. Diabetic ketoacidosis. Nat Rev Dis Primers. 2020 May 14;6(1):40.
http://www.ncbi.nlm.nih.gov/pubmed/32409703?tool=bestpractice.com
Between 6% and 21% of adults present with DKA at the time of initial diagnosis of type 1 diabetes.[1]Umpierrez GE, Davis GM, ElSayed NA, et al. Hyperglycaemic crises in adults with diabetes: a consensus report. Diabetologia. 2024 Aug;67(8):1455-79.
https://link.springer.com/article/10.1007/s00125-024-06183-8
http://www.ncbi.nlm.nih.gov/pubmed/38907161?tool=bestpractice.com
In people with preexisting type 2 diabetes, DKA may be triggered by conditions of physiologic stress (such as infections, trauma, or cardiovascular events) or by the use of certain drugs (e.g., sodium-glucose cotransporter-2 [SGLT2] inhibitors, and the dual SGLT1/SGLT2 inhibitor sotagliflozin). DKA has also been increasingly documented as a presenting feature of newly diagnosed type 2 diabetes; this is referred to as ketosis-prone diabetes mellitus.[9]Dhatariya KK, Glaser NS, Codner E, et al. Diabetic ketoacidosis. Nat Rev Dis Primers. 2020 May 14;6(1):40.
http://www.ncbi.nlm.nih.gov/pubmed/32409703?tool=bestpractice.com
[10]Kovacs A, Bunduc S, Veres DS, et al. One third of cases of new-onset diabetic ketosis in adults are associated with ketosis-prone type 2 diabetes-a systematic review and meta-analysis. Diabetes Metab Res Rev. 2024 Mar;40(3):e3743.
https://onlinelibrary.wiley.com/doi/10.1002/dmrr.3743
http://www.ncbi.nlm.nih.gov/pubmed/37888894?tool=bestpractice.com
Since the early 2000s, the prevalence of ketosis-prone type 2 diabetes worldwide has increased, with epidemiologic data suggesting that people of African or Hispanic origin are at greater risk.[9]Dhatariya KK, Glaser NS, Codner E, et al. Diabetic ketoacidosis. Nat Rev Dis Primers. 2020 May 14;6(1):40.
http://www.ncbi.nlm.nih.gov/pubmed/32409703?tool=bestpractice.com
Most often, individuals with ketosis-prone type 2 diabetes have obesity and a strong family history of type 2 diabetes, as well as evidence of insulin resistance.[9]Dhatariya KK, Glaser NS, Codner E, et al. Diabetic ketoacidosis. Nat Rev Dis Primers. 2020 May 14;6(1):40.
http://www.ncbi.nlm.nih.gov/pubmed/32409703?tool=bestpractice.com
As the majority of people with DKA are hospitalized, most epidemiologic data come from hospital discharge coding.[9]Dhatariya KK, Glaser NS, Codner E, et al. Diabetic ketoacidosis. Nat Rev Dis Primers. 2020 May 14;6(1):40.
http://www.ncbi.nlm.nih.gov/pubmed/32409703?tool=bestpractice.com
From 2000 to 2009, the rate of hospitalizations for DKA in the US decreased overall, from 21.9 to 19.5 in 1000 persons with diabetes, but then increased to 30.2 in 1000 persons with diabetes in 2014.[11]Benoit SR, Zhang Y, Geiss LS, et al. Trends in diabetic ketoacidosis hospitalizations and in-hospital mortality - United States, 2000-2014. MMWR Morb Mortal Wkly Rep. 2018 Mar 30;67(12):362-65.
https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a3.htm?s_cid=mm6712a3_w
http://www.ncbi.nlm.nih.gov/pubmed/29596400?tool=bestpractice.com
In 2014, rates of hospitalization for DKA were highest among people age <45 years (44.3 in 1000 persons with diabetes) and decreased with age (5.2 in 1000 persons with diabetes ages 45-64 years; 1.6 in 1000 65-74 years; and 1.4 in 1000 ≥75 years).[11]Benoit SR, Zhang Y, Geiss LS, et al. Trends in diabetic ketoacidosis hospitalizations and in-hospital mortality - United States, 2000-2014. MMWR Morb Mortal Wkly Rep. 2018 Mar 30;67(12):362-65.
https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a3.htm?s_cid=mm6712a3_w
http://www.ncbi.nlm.nih.gov/pubmed/29596400?tool=bestpractice.com
In 2020, 10.2 in 1000 adults with diabetes in the US visited emergency departments with DKA.[12]Centers for Disease Control and Prevention. Diabetes: national diabetes statistics report. May 2024 [internet publication].
https://www.cdc.gov/diabetes/php/data-research
From 2000 to 2014, in-hospital mortality rates among people with DKA consistently decreased in the US, from 1.1% to 0.4%.[11]Benoit SR, Zhang Y, Geiss LS, et al. Trends in diabetic ketoacidosis hospitalizations and in-hospital mortality - United States, 2000-2014. MMWR Morb Mortal Wkly Rep. 2018 Mar 30;67(12):362-65.
https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a3.htm?s_cid=mm6712a3_w
http://www.ncbi.nlm.nih.gov/pubmed/29596400?tool=bestpractice.com
Mortality rates reported in low- and middle-income countries are much higher, potentially because of delayed diagnosis and treatment.[1]Umpierrez GE, Davis GM, ElSayed NA, et al. Hyperglycaemic crises in adults with diabetes: a consensus report. Diabetologia. 2024 Aug;67(8):1455-79.
https://link.springer.com/article/10.1007/s00125-024-06183-8
http://www.ncbi.nlm.nih.gov/pubmed/38907161?tool=bestpractice.com
Data from India have shown a 30% mortality rate in those presenting with DKA, and studies from sub-Saharan Africa have reported similarly high mortality (26% to 41%).[9]Dhatariya KK, Glaser NS, Codner E, et al. Diabetic ketoacidosis. Nat Rev Dis Primers. 2020 May 14;6(1):40.
http://www.ncbi.nlm.nih.gov/pubmed/32409703?tool=bestpractice.com
Mortality increases substantially in those with comorbidities and with aging, reaching 8% to 10% in those ages 65-75 years.[9]Dhatariya KK, Glaser NS, Codner E, et al. Diabetic ketoacidosis. Nat Rev Dis Primers. 2020 May 14;6(1):40.
http://www.ncbi.nlm.nih.gov/pubmed/32409703?tool=bestpractice.com