Epidemiology

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]​ Between 6% and 21% of adults present with DKA at the time of initial diagnosis of type 1 diabetes.[1]​ 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][10]​ 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]​ 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]

As the majority of people with DKA are hospitalized, most epidemiologic data come from hospital discharge coding.[9]​ 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] 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] In 2020, 10.2 in 1000 adults with diabetes in the US visited emergency departments with DKA.[12]

From 2000 to 2014, in-hospital mortality rates among people with DKA consistently decreased in the US, from 1.1% to 0.4%.[11] Mortality rates reported in low- and middle-income countries are much higher, potentially because of delayed diagnosis and treatment.[1]​ 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]​ Mortality increases substantially in those with comorbidities and with aging, reaching 8% to 10% in those ages 65-75 years.[9]

Use of this content is subject to our disclaimer