Increased Risk of Death Following Recurrent Ketoacidosis Admissions: A Brazilian Cohort Study of Young Adults with Type 1 Diabetes

Abstract

Abstract Background: Recurrent DKA (rDKA) remains an acute type 1 diabetes complication even in post-insulin era. This study aimed to analyze the predictors and effects of rDKA on the mortality of patients with type 1 diabetes. Methods: Patients hospitalized (n = 231) wih diabetic ketoacidosis (between 2007 to 2018) were included. Laboratorial and clinical variables were collected. Mortality curves were compared in four groups: diabetic ketoacidosis as a new-onset type 1 diabetes (group A), single diabetic ketoacidosis episode after diagnosis of type 1 diabetes (group B), 2–5 diabetic ketoacidosis events (group C), and >5 diabetic ketoacidosis events during follow-up period (group D). Results: During the follow-up period (approximately 1823 days), the mortality rate was 16.02% (37/231). The median age at death was 38.7 years. In the survival curve analysis, at 1926 days (5 years), the probabilities of death were indicated by ratios of 7.78%, 4.58%, 24.40%, and 26.63% in groups A, B, C, and D, respectively. One diabetic ketoacidosis episode compared with ≥2 events had a relative risk of 4.49 (p = 0.004) of death. Neuropathy (relative risk 10.04; p < 0.001), retinopathy (relative risk 7.94; p < 0.01), nephropathy (relative risk 7.10; p < 0.001), mood disorders (relative risk 3.57; p = 0.002), antidepressant use (relative risk 3.09; p = 0.004), and statin use (relative risk 2.81; p = 0.0024) increased the risk of death. Conclusions: Patients with type 1 diabetes with >2 diabetic ketoacidosis episodes have four times greater risk of death in 5 years. Microangiopathies, mood disorders, and use of antidepressants and statins were important risk factors for short-term mortality.