From 2000 to 2014, in-hospital mortality rates among people with diabetic ketoacidosis (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 in those presenting with DKA, and studies from sub-Saharan Africa have reported similarly high mortality (26% to 41.3%).[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
Death is rarely caused by the metabolic complications of hyperglycemia or ketoacidosis but rather relates to the underlying illness.
Mortality rates remain increased even after recovery. One New Zealand-based cohort study found that people discharged after an episode of DKA had a 1 year age-corrected mortality rate that was 13 times higher than the general population.[98]Shand JAD, Morrow P, Braatvedt G. Mortality after discharge from hospital following an episode of diabetic ketoacidosis. Acta Diabetol. 2022 Nov;59(11):1485-92.
http://www.ncbi.nlm.nih.gov/pubmed/35951132?tool=bestpractice.com
This was more pronounced among younger individuals (ages 15-39 years), in whom the mortality rate was 49 times higher than the general population.[98]Shand JAD, Morrow P, Braatvedt G. Mortality after discharge from hospital following an episode of diabetic ketoacidosis. Acta Diabetol. 2022 Nov;59(11):1485-92.
http://www.ncbi.nlm.nih.gov/pubmed/35951132?tool=bestpractice.com
In one US-based cohort study, all-cause mortality within 30 days of a hyperglycemic crisis was 0.1% among patients with type 1 diabetes and 2% among patients with type 2 diabetes. The 1 year mortality rates were 0.9% and 9.5% in patients with type 1 diabetes and type 2 diabetes, respectively.[99]McCoy RG, Herrin J, Galindo RJ, et al. All-cause mortality after hypoglycemic and hyperglycemic emergencies among U.S. adults with diabetes, 2011-2020. Diabetes Res Clin Pract. 2023 Mar;197:110263.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10023431
http://www.ncbi.nlm.nih.gov/pubmed/36693542?tool=bestpractice.com
A substantial proportion of individuals hospitalized with DKA experience recurrent episodes.[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 one US-based study conducted between 2006 and 2012, 21.6% of people hospitalized for DKA had more than one episode over 6 years, with 5.8% of individuals accounting for 26.3% of DKA hospitalizations.[100]Mays JA, Jackson KL, Derby TA, et al. An evaluation of recurrent diabetic ketoacidosis, fragmentation of care, and mortality across Chicago, Illinois. Diabetes Care. 2016 Oct;39(10):1671-6.
https://diabetesjournals.org/care/article/39/10/1671/134/An-Evaluation-of-Recurrent-Diabetic-Ketoacidosis
http://www.ncbi.nlm.nih.gov/pubmed/27422579?tool=bestpractice.com
In another study conducted in the UK, patients with 2-5 admissions had a threefold higher risk of death compared with those with a single DKA admission, while those with six or more admissions had a sixfold higher risk of death.[101]Gibb FW, Teoh WL, Graham J, et al. Risk of death following admission to a UK hospital with diabetic ketoacidosis. Diabetologia. 2016 Oct;59(10):2082-7.
https://pmc.ncbi.nlm.nih.gov/articles/PMC5016550
http://www.ncbi.nlm.nih.gov/pubmed/27397023?tool=bestpractice.com
Recurrent DKA is a risk factor for the development of cognitive impairment in those with type 1 diabetes.[4]American Diabetes Association. Standards of care in diabetes - 2025. Diabetes Care. 2025 Jan ;48(suppl 1):S1-352.
https://diabetesjournals.org/care/issue/48/1
In one study of older adults with type 1 diabetes, recurrent DKA was associated with lower global cognitive function scores and lower executive function/psychomotor speed scores.[102]Lacy ME, Gilsanz P, Eng CW, et al. Recurrent diabetic ketoacidosis and cognitive function among older adults with type 1 diabetes: findings from the Study of Longevity in Diabetes. BMJ Open Diabetes Res Care. 2020 Jun;8(1):e001173.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7299028
http://www.ncbi.nlm.nih.gov/pubmed/32546548?tool=bestpractice.com