Use of tobacco, cannabis and psychoactive substances increases risk of readmission due to DKA in type 1 diabetes

Diabetic ketoacidosis (DKA) is a preventable, deadly, and costly complication of type 1 diabetes mellitus (T1DM). Some individuals with type 1 diabetes mellitus have recurrent Diabetic ketoacidosis admissions. They sought to characterize social factors that differ between patients with single vs multiple Diabetic ketoacidosis admissions at an urban, safety-net hospital. They queried the electronic health records for type 1 diabetes mellitus patients admitted for Diabetic ketoacidosis from 2019 to 2021. Admission laboratory values, demographic information, and detailed social histories were collected and analyzed statistically, including logistical regression. Results: A total of 243 patients were admitted for Diabetic ketoacidosis, 64 of whom had multiple Diabetic ketoacidosis admissions. There was no significant difference between the groups in their admission laboratory values, hospital length of stay, health-care payer status, history of homelessness, current employment, living alone, independence of activities of daily living, and barriers to discharge. Type 1 diabetes mellitus patients with multiple Diabetic ketoacidosis admissions had greater rates of substance use disorder, especially with cannabis, tobacco, and psychoactive substance use. Regression models of substance use showed increased risk with any substance use and cannabis. They identified substance use as a possible predictor of type 1 diabetes mellitus patients at risk for multiple Diabetic ketoacidosis admissions. The findings identify a group of type 1 diabetes mellitus patients for whom interventions may help to decrease the recurrence of Diabetic ketoacidosis episodes within similar community hospital populations.

Reference:

Josh Peedikayil, Shrenika Reddy, Rohit Nair, Uma Gunasekaran, Carolyn Nelson, Musa Shakoor, Zahid Ahmad, Social and Metabolic Characteristics Associated With Multiple DKA Admissions at a Large County Hospital, Journal of the Endocrine Society, Volume 8, Issue 3, March 2024, bvad173, https://doi.org/10.1210/jendso/bvad173

Keywords:

Use of tobacco, cannabis, psychoactive substances, increases risk, readmission, diabetic ketoacidosis, type 1 diabetes, Josh Peedikayil, Shrenika Reddy, Rohit Nair, Uma Gunasekaran, Carolyn Nelson, Musa Shakoor, Zahid Ahmad, Journal of the Endocrine Society, diabetic ketoacidosis, type 1 diabetes mellitus, substance use, hospital admissions, safety-net hospital