Data & Trends

Diabetes Surveillance System

1999 Surveillance Report

Chapter 7: Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a major acute metabolic complication of diabetes that is related to a deficiency in insulin (24). DKA may require hospitalization for treatment and increases the use of health care services and the cost of diabetes. This report finds that DKA continues to be more problematic for blacks than for whites.

In 1996, DKA was the first-listed diagnosis for 100,000 hospital discharges and a listed diagnosis on 122,000 hospital discharges (Figure 7.1, Table 7.1, 7.4). The average length of stay for a first-listed diagnosis of DKA were higher in the two older age groups (persons 45 years of age) (Figure 7.2), decreased over 40% between 1980 and 1996, and averaged 4.5 days in 1996 (Figure 7.2, Table 7.1).

In general, although the trend was not monotonic, age-adjusted rates of hospital discharge for DKA as first-listed diagnosis and as a listed diagnosis per 1,000 persons with diabetes increased from 1980 to 1984, decreased through 1994, and then increased slightly in 1995 and 1996 (Figure 7.4, Table 7.13, Table 7.16). DKA hospital discharge rates were highest among those <45 years of age (Figure 7.5, Table 7.13, Table 7.16). In 1996, the hospital discharge rate for DKA as first-listed diagnosis was more than 25 times higher for persons <45 years of age than for those 65 years of age.

DKA discharge rates were similar for males and females (Figure 7.6, Table 7.14, and Table 7.17), but were more than 2 times higher for blacks than for whites (Figure 7.7, Table 7.15, and Table 7.18). In 1996, the age-adjusted rates of hospital discharge for DKA as first-listed diagnosis among blacks was 2.3 times that of whites (19.7 vs 8.4 per 1,000 diabetic population).

The number of deaths with DKA as the underlying cause (DKA deaths) and any listed cause of death (DKA-related deaths) varied little between 1980 and 1996 (Figure 7.8, Table 7.19, Table 7.26). In general, age-adjusted death rates per 100,000 diabetic population for DKA and DKA-related deaths declined between 1980 and 1996 (Figure 7.10, Table 7.33, Table 7.40). The age-adjusted DKA death rate was 34% lower in 1996 than in 1980 and the DKA-related death rate were 35% lower. Decreases in DKA death rates were seen in all age groups, except in the youngest age group (i.e., those 45 years of age).

In general, persons with diabetes 75 years of age had the highest DKA death rates, followed by persons 45 years of age. Among those 45 years of age, DKA death rates were higher in 1996 than in 1980 for all race-sex groups except white females. Among the race-sex groups examined, DKA age-adjusted death rates were highest among black males, followed by black females and then by white males and females (Figure 7.12, Tables 7.36, 7.37, 7.38, and 7.39). In 1996, the age-adjusted DKA death rate for black males was more than twice that for white females (36.8 vs 16.8 per 100,000 diabetic population). Similar trends are seen in DKA-related death rates (Tables 7.43, 7.44, 7.45, and 7.46).

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This page last reviewed January 18, 2005.

United States Department of Health and Human Services
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation