Category: Diabetes/Prediabetes/Hypoglycemia

Type: e-Poster

Monitor: 11

11 - INCIDENCE AND ASSOCIATED RISK FACTORS OF DIABETIC KETOACIDOSIS IN HYPERGLYCEMIC ADULT PATIENTS WITH TYPE 1 DIABETES: RESULTS FROM THE T1D EXCHANGE CLINIC REGISTRY

Thursday, Apr 25
12:30 PM – 1:00 PM

Objective : Research has shown that increase in diabetic ketoacidosis (DKA) incidence is associated with lower age, socioeconomic status, and higher glycated hemoglobin (A1C) in patients with type 1 diabetes (T1D). This cross-sectional analysis evaluated DKA incidence and risk factors associated with DKA in hyperglycemic adults with T1D using the 2016-2017 Type 1 Diabetes Exchange Clinic Registry dataset.


Methods : DKA was defined ≥1 DKA event from the participant questionnaire or medical record during the previous 15 months. Associations between patient characteristics (age, T1D duration, sex, race, education and income level, insurance, marital and smoking status, and body mass index [BMI]); and treatment patterns (insulin, continuous glucose monitoring, non-insulin medications for glucose control, and statins), with the occurrence of a DKA event were evaluated in 3 A1C categories (7 to <8, 8 to <9, and ≥9%). Univariate comparisons between DKA and non-DKA groups in each A1C category were made using chi-square or Fisher’s exact tests for categorical variables and t tests for continuous variables. Association between risk factors and DKA was analyzed using multivariate logistic regression models in each A1C category. Data analyses were conducted using SAS software (ver 9.4; SAS Institute, Cary, NC) with 2-sided p values of 0.05 significance.


Results : Of 6242 patients included in the analysis, 43, 31, and 30% had A1C 7 to <8, 8 to <9, and ≥9%, respectively. Of the total patients, 269 (4.3%) reported a DKA event, and 1.7% (7 to <8%), 2.3% (8 to <9%), and 9.5% (≥9%) had a DKA episode. No individual patient demographic, socioeconomic, or treatment patterns were significantly associated with DKA incidence in the A1C 7 to <8% cohort. Race, marital status, insurance coverage, and annual household income were significantly (p<0.01) associated with DKA incidence in the A1C 8 to <9% cohort. In the A1C ≥9% cohort, in addition to the factors in the A1C 8 to <9% cohort, DKA was significantly (p<0.01) associated with age, T1D duration, sex, education level, BMI, and insulin delivery method. In multivariate adjusted models, no factors were significantly associated with DKA in the A1C 8 to <9% cohort, and only household income, smoking status, BMI, and insulin delivery method (injection) were significantly associated with DKA in the A1C ≥9% cohort.


Discussion : DKA incidence increased with increasing A1C and was greatest in those with A1C ≥9%.


Conclusion : When managing the risk of DKA in adults with T1D (in particular patients with A1C ≥9%), patient factors related to smoking and socioeconomic status, BMI, and insulin delivery method should be considered.

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Carol H. Wysham

Section Head
MultiCare Rockwood Clinic
Spokane, Washington

Dr Wysham is Section Head of the the Rockwood Center for Diabetes and Endocrinology in Spokane, WA, and Clinical Professor of Medicine at the University of Washington in Seattle.

Amy Carroll

Medical Director, Diabetes
Lexicon Pharmaceuticals, Inc.
Basking Ridge, New Jersey

Amy is a Medical Director in Lexicon Pharmaceuticals, Inc.

Ronald Preblick

Senior Director
Sanofi
Bridgewater, New Jersey

Ronald is a Sr. Director in Sanofi providing global Health Economic support within Diabetes franchise.

Fang Liz Zhou

Director
Sanofi
Bridgewater, New Jersey

Liz is a director of Real World Study Lead Metabolism, Global Medical Evidence Generation, in Sanofi, providing strategic and scientific leadership in the planning, design, execution and publication and dissemination of Real World epidemiological/outcome research studies.

Amy Carroll

Medical Director, Diabetes
Lexicon Pharmaceuticals, Inc.
Basking Ridge, New Jersey

Amy is a Medical Director in Lexicon Pharmaceuticals, Inc.

Sachin Paranjape

Medical Director, Diabetes Medical Affairs
Sanofi

Sachin is a Medical Director in Sanofi, with extensive involvement and experience in key Medical Affairs functions.

Vijay N. Joish

Executive Director, Epidemiology & Outcomes Research
Lexicon Pharmaceuticals, Inc.
Basking Ridge, New Jersey

Vijay is an Executive Director in Lexcion Pharmaceuticals, Inc., experiencing in developing health outcomes, epidemiology and pharmacoeconomic evidence.