Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Predictors of DKA readmission to a regional hospital:  A ten-year retrospective audit (#267)

Sheila J Cook 1 2 , Marcella Kwan 1 , Rashmi Gururajan 3 , Jemma Noakes 2
  1. The University of Queensland, Toowoomba, QLD, Australia
  2. Toowoomba Hospital, Toowoomba, QLD, Australia
  3. Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia

Introduction:

Diabetic ketoacidosis (DKA) is the commonest reason for people with Type 1 Diabetes to be admitted to hospital in Australia, accounting for 37% of hospital admissions in 2014-15 (1). 

Preventing DKA hospital admission is an important priority of care for people with Type 1 Diabetes (2), however, predicting who is at risk remains challenging (3,4).

Objectives:  

To identify risk factors for hospital readmission for DKA in patients with type 1 diabetes presenting to a regional hospital.

Methods:

A retrospective chart audit was conducted at Toowoomba Hospital for patients admitted with a diagnosis of DKA in the ten-year period 2006 - 2015.

Results

There were admissions for DKA occurring in 258 people.  The mean age at index admission was 28.2 ± 18.0 years (range 1 - 88 years).

The commonest precipitants for admission were non-adherence (52.1%), infection (30.9%), alcohol-related events (7.3%) and gastroenteritis (5.8%).

169 people experienced a single admission for DKA compared with 89 people who were admitted multiple times, with 51.6% being readmitted within 1 year. Univariate analysis shows the following risks factors were significantly associated with readmission for DKA: illicit drug use (OR 10.00 (95%CI 1.15-86.97), smoking (OR 2.49 (95%CI 1.47-4.22)), alcohol (OR 1.79 (95% CI 1.06-3.02)), depression/anxiety (OR 2.57 (95%CI 1.50-4.42), personality disorder (OR 3.66 95% CI 2.08-6.42) and presence of gastroparesis (OR 4.16 (95%CI 2.10-8.26), neuropathy (OR 3.24 (95%CI 1.88-5.57), nephropathy (OR 2.15 (95%CI 1.23-3.76)), and retinopathy (OR 2.88 (95%CI 1.65-5.03) ). Patients who were seen by DNE were less likely to be readmitted (OR 0.51 (95%CI 0.27-0.96)).  A documented sick day plan was not protective against hospital readmission (OR 0.89 (95% CI 0.52-1.52)).

Conclusion

Substance abuse, mental health disorders and diabetes complications are significant risk factors for readmission with DKA.   Patients identified with these risk factors require social support to prevent readmission.

  1. Australian Institute of Health and Welfare 2016. Diabetic ketoacidosis (DKA) among children and young people with type 1 diabetes. Diabetes series no. 26. Cat. no. CVD 77. Canberra: AIHW.
  2. Craig ME, Twigg SM, Donaghue KC, Cheung NW, Cameron FJ, Conn J et al. 2011. National evidence-based clinical care guidelines for type 1 diabetes in children, adolescents and adults. Canberra: Department of Health and Ageing.
  3. Dungan KM. The Effect of Diabetes on Hospital Readmissions. J Diabetes Sci Technol 2012;6(5):1045-1052
  4. Weinert LS, Scheffel RS, Severo MD, Cioffi AP, Telo GH, Boschi A, Schaan BD. Precipitating factors of Diabetic ketoacidosis at a public hospital in a middle-income country. Diab Res Clin Pract 96: 29-34