Prognosis

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] 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 in those presenting with DKA, and studies from sub-Saharan Africa have reported similarly high mortality (26% to 41.3%).[9] Mortality increases substantially in those with comorbidities and with aging, reaching 8% to 10% in those ages 65-75 years.​​​[9]​ 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]​ 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] ​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]

A substantial proportion of individuals hospitalized with DKA experience recurrent episodes.​[1]​ 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] 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]

Recurrent DKA is a risk factor for the development of cognitive impairment in those with type 1 diabetes.​[4] 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]

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