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Substance Abuse Ups DKA Readmission Risk in Type 1 Diabetes
TOPLINE:
Significant associations were found between readmission with diabetic ketoacidosis (DKA) in people with type 1 diabetes (T1D) and both substance abuse and incarceration.
METHODOLOGY:
At a large county hospital in Texas, an electronic health records query for patients with T1D admitted with a DKA diagnosis between 2019 and 2021 identified 243 with at least one admission, of whom, 64 were admitted two or more times (median 2, range 1-29).
TAKEAWAY:
- In the total patient population, 40.3% of patients had at least one substance use disorder diagnosis.
- Substance use disorder was identified in 60.9% of the 64 patients with multiple DKA admissions vs 33.0% of the 179 patients with a single admission (P < .001).
- Compared with patients with a single DKA admission, those with multiple admissions had significantly higher rates of using tobacco (26.3% vs 46.3%; P = .002), cannabis (6.7% vs 25.0%; P < .001), and psychoactive substances (1.1% vs 6.3%; P = .043).
- No usage differences were found for alcohol, opioid, or cocaine use.
- In univariate analysis, DKA readmission odds were more than triple for any substance use (odds ratio, 3.17; P < .001).
- In multivariable analysis, cannabis use remained independently associated with a significantly increased odds of DKA readmission (3.70; P = .003).
- Patients with multiple DKA admissions were significantly more likely to have a history of incarceration (26.6% vs 14.5%; P = .007)
IN PRACTICE:
"Our findings identify a group of [patients with T1D] for whom interventions may help to decrease recurrence of DKA episodes within similar community hospital populations."SOURCE:
The study was conducted by Josh Peedikayil, MD, a first-year resident at the University of Texas Southwestern Medical School, Dallas, and colleagues and was published online on January 19 in the Journal of the Endocrine Society.
LIMITATIONS:
- Single center
- Limited time period
- Potential for chart data inaccuracies and differences in DKA criteria
- Precipitants of DKA unknown
DISCLOSURES:
The study received no funding.
Miriam E. Tucker is a freelance journalist based in the Washington DC area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR's Shots blog, and Diabetes Forecast magazine. She is on Twitter @MiriamETucker.
