Data & Trends

Diabetes Surveillance System

1999 Surveillance Report

Chapter 1: The Public Health Burden of Diabetes Mellitus in the United States

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 among blacks than among 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, Tables 7.1 and 7.4). The average length of stay for a first-listed diagnosis of DKA was higher in the two older age groups (persons aged greater than or equal to 45 years) (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, the age-adjusted rates of hospital discharge for DKA as a 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, Tables 7.13 and 7.16). DKA hospital discharge rates were highest among those aged <45 years (Figure 7.5, Tables 7.13 and 7.16). In 1996, the hospital discharge rate for DKA as a first-listed diagnosis was over 25 times higher among persons aged <45 years than among those aged greater than or equal to 65 years.

DKA discharge rates were similar among men and women (Figure 7.6, Tables 7.14 and 7.17) but were more than 2 times higher among blacks than among whites (Figure 7.7, Tables 7.15 and 7.18). In 1996, the age-adjusted rate of hospital discharge for DKA as a 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 as any listed cause of death (DKA-related deaths) varied little between 1980 and 1996 (Figure 7.8, Tables 7.19 and 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, Tables 7.33 and 7.40). The age-adjusted DKA death rate was 34% lower in 1996 than in 1980, and the DKA-related death rate was 35% lower. Decreases in DKA death rates were seen in all age groups except in the youngest age group (i.e., those aged <45 years).

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