Profile of diabetic ketoacidosis in a predominantly African American urban patient population.
The occurrence of diabetic ketoacidosis (DKA), a serious but largely preventable acute complication of diabetes mellitus, has been declining in recent years. However, empiric observations indicate that DKA continues to have a major effect on ethnic minority patients in inner-city settings. In this study, we conducted a retrospective analysis of five-year hospital admission data for DKA at a single inner-city hospital that serves a largely uninsured adult African American population. A computer-assisted search of the International Classification of Diseases, Ninth Revision, Clinical Modification codes for DKA revealed 847 admissions for confirmed DKA in 630 patients. Of these, 592 (94%) were African Americans, 22 (3.5%) were Whites, and 16 (2.5%) were Hispanics. The mean age was 43.4 +/- .4 years. Five hundred seventy-one (90.6%) of the patients had type 1 diabetes, and 59 (9.4%) had type 2 diabetes. One hundred forty-five patients (23%) were newly diagnosed with diabetes. Ninety-four (14.9%) of the patients had multiple admissions, ranging from 2 to 23 admissions per patient during the five-year period, while the remaining 391 (62.1%) patients were single admissions. Half of the patients (52%) did not have health insurance. Major precipitating factors for DKA included discontinuation of insulin, infection, and other medical illness in 501 (59.1%), 136 (16.1%), and 30 (3.5%) of the admissions, respectively. In conclusion, these data demonstrate that DKA continues to have a major effect in urban African American patients with diabetes. Therefore, multiple targeted interventions are needed in this population to improve diabetes care and thereby decrease the frequency of DKA.
Division of Endocrinology, Diabetes, and Metabolism, Wayne State University School of Medicine, Detroit, MI 48201, USA. bseyoum@med.wayne.edu
Berhane
B
Seyoum
Paulos
P
Berhanu
D000328:Adult; D001741:Black or African American; D016883:Diabetic Ketoacidosis / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D010343:Patient Admission; D012189:Retrospective Studies; D014505:Urban Population