Having multiple readmissions for diabetes ketoacidosis (DKA) was more likely to occur among patients with type 1 diabetes (T1D) with substance use disorder or who previously were incarcerated.
Researchers of a new study have identified certain social and behavioral factors associated with repeat hospital admissions for diabetes ketoacidosis (DKA) among patients with type 1 diabetes (T1D).
Over the 2-year study period (2019-2011), 26% of 243 patients admitted to a single center for DKA were admitted at least twice for the complication. Having multiple readmissions was more likely to occur among patients with substance use disorder or who previously were incarcerated.
The findings published in Journal of the Endocrine Society, wrote the researchers, help identify specific patient groups for whom interventions can be implemented in order to lower the recurrence of DKA episodes. Interventions, they underscored, should include perspectives from patients about what interventions could be most effective.
Rates of substance use disorder were nearly twice as high (60.9% vs 33.0%; P < .001) among patients with multiple admissions than among patients admitted just once over the study period. Patients with multiple admissions were also significantly more likely to have been incarcerated (26.6% vs 14.5%; P = .007). This association, said the researchers, offers a new insight to previous research exploring the effect of previous incarceration on DKA admissions.
“While there has been much research looking at the increased risk of DKA and hyperosmolar hyperglycemic syndrome in patients who are in prison, few studies have looked at these events in those following release,” described the researchers. “Randall et al, in their 2011 study of 164 minority patients with DKA at a similar large community hospital, did not find a difference between those with a single vs multiple DKA episodes. However, they similarly did see a significant increase in incarceration history as the number of admissions increased.”
The group highlighted a similar pattern among research on the effect of substance abuse, noting that although various studies have explored the link between substance abuse/disorder and DKA readmission, few have gone deeper into differences based on type of substance. In the current study, multivariate analysis shows that among substances, which included cannabis, tobacco, and psychoactive substances, only cannabis was independently associated with multiple admissions.
Across other psychosocial factors, the researchers found no significant differences between patients who were admitted for DKA once vs those who had multiple DKA admissions. These factors included laboratory values, length of hospital stay, coverage type, history of homelessness, employment status, living alone, independence of daily activities, and barriers to discharge.
From a clinical perspective, there were no differences in diagnostic diabetes and DKA lab values between the 2 patient groups, nor were there statistical differences in length of hospital stay.
“A lipid panel is typically not a standard laboratory test that is run on patients admitted for DKA. Likely for that reason, only 83 patients admitted for DKA had a lipid test drawn throughout their admission,” explained the researchers. “However, there was a significant increase in the level of HDL-C [high-density lipoprotein cholesterol] in those with readmissions for DKA. The association between T1D and HDL-C level has been explored in multiple studies; however, none have shown an association between HDL-C levels and incidence of DKA or recurrent DKA in this population. Our findings are unlikely to be related to selection bias among individuals who had lipid measurements taken, as there were no demographic differences between those with and without lipid measurements.”
Mean cholesterol levels, low-density lipoprotein cholesterol, and serum triglycerides were comparable between the two groups.
Reference
Peedikayil J, Reddy S, Nair R, et al. Social and metabolic characteristics associated with multiple DKA admissions at a large county hospital. J Endocr Soc. Published online January 19, 2024. doi:10.1210/jendso/bvad173
The Joint Commission is launching the Rural Health Clinic Accreditation Program to standardize staff training and patient care practices at rural health clinics nationwide; the American Cancer Society recently launched the largest-ever study of cancer risk and outcomes in Black women; the HHS COVID-19 vaccination campaign saved $732 billion by preventing illness and related costs.
Read More
CMS Medicare Final Rule: Advancing Benefits, Competition, and Consumer Protection
May 7th 2024On this episode of Managed Care Cast, we're talking with Karen Iapoce, senior director of government products and programs at ZeOmega, about the recent CMS final rule on Medicare Part D and Medicare Advantage.
Listen
Tackling Health Inequality: The Power of Education and Experience
April 30th 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. Welcome to our final episode of this limited series and our conversation with Janine Jelks-Seale, MSPPM, director of health equity at UPMC Health Plan.
Listen
Access Denied: CMS’ Action Hurts Patients With Cancer in Rural America
May 6th 2024CMS rules hindered the access of rural patients with cancer to medically integrated pharmacies in 2023. The authors discuss the impact on equity in health care, emphasizing the need for regulatory change.
Read More
What Mass General Brigham Is Doing to Combat Prostate Cancer Disparities Among Men of Color
May 5th 2024Quoc-Dien Trinh, MD, MBA, chief of urology at Brigham & Women's Faulkner Hospital, highlighted successful efforts to improve prostate cancer care access for underserved communities in Massachusetts.
Read More
The Joint Commission is launching the Rural Health Clinic Accreditation Program to standardize staff training and patient care practices at rural health clinics nationwide; the American Cancer Society recently launched the largest-ever study of cancer risk and outcomes in Black women; the HHS COVID-19 vaccination campaign saved $732 billion by preventing illness and related costs.
Read More
CMS Medicare Final Rule: Advancing Benefits, Competition, and Consumer Protection
May 7th 2024On this episode of Managed Care Cast, we're talking with Karen Iapoce, senior director of government products and programs at ZeOmega, about the recent CMS final rule on Medicare Part D and Medicare Advantage.
Listen
Tackling Health Inequality: The Power of Education and Experience
April 30th 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. Welcome to our final episode of this limited series and our conversation with Janine Jelks-Seale, MSPPM, director of health equity at UPMC Health Plan.
Listen
Access Denied: CMS’ Action Hurts Patients With Cancer in Rural America
May 6th 2024CMS rules hindered the access of rural patients with cancer to medically integrated pharmacies in 2023. The authors discuss the impact on equity in health care, emphasizing the need for regulatory change.
Read More
What Mass General Brigham Is Doing to Combat Prostate Cancer Disparities Among Men of Color
May 5th 2024Quoc-Dien Trinh, MD, MBA, chief of urology at Brigham & Women's Faulkner Hospital, highlighted successful efforts to improve prostate cancer care access for underserved communities in Massachusetts.
Read More
2 Commerce Drive
Cranbury, NJ 08512