SAN DIEGO — Deaths from diabetic ketoacidosis among adults in the United States decreased by one-third between 1984 and 2002, Jing Wang and her associates reported in a poster at the annual scientific sessions of the American Diabetes Association.
There was no decline, however, in diabetic ketoacidosis (DKA) deaths among black men, and a large proportion of DKA deaths continue to occur at home or prior to arrival at the emergency department, said Ms. Wang, a health care analyst with Northrop Grumman/Information Technology, supporting the division of diabetes translation at the Centers for Disease Control and Prevention, Atlanta.
The data were derived from vital records of patients with diabetes seen in 1984–1998 using ICD-9 codes and in 1999–2002 using ICD-10 codes. Estimates of the U.S. diabetic population came from the National Health Interview Survey.
Between 1984 and 2002, the age-adjusted DKA death rate dropped from 30.5 to 20.5 per 100,000 diabetics. Declines occurred in all age groups, ranging from a 65% drop among individuals aged 65 and older to a 22% drop among those aged 18–44.
Age-adjusted DKA death rates declined by 18% among white men, 35% among white women, and 46% among black women. The rates for black men, on the other hand, remained essentially unchanged, averaging at least twice that of the other groups, the investigators noted.
In 2002, 52% of DKA deaths occurred in the hospital, 12% in emergency departments/outpatient clinics, 26% at a residence, and 10% in other places.
From 1992 (the first year for which place-of-death data were available) through 2002, DKA death rates declined in all health care sites, dropping by 49% in hospitals, 38% in emergency departments/outpatient clinics, and 59% in nursing homes. For all health care sites combined, the DKA death rate dropped from 19 to 10.3 per 100,000 from 1992 to 2002.
However, the rate of DKA deaths occurring at the patient's residence remained essentially unchanged between 1992 (3.5/100,000) and 2002 (3.7/100,000).
The number of DKA deaths still occurring at home is of concern, particularly since the condition is both preventable and treatable. “A better understanding of how to prevent their occurrence is essential,” the investigators wrote.