Population‐based incidence of diabetic ketoacidosis in type 2 diabetes: medical claims data analysis in Japan

• Published in: Pharmacoepidemiology and drug safety 2018-01, Vol.27 (1), p.123-126
• Main Authors: Takeuchi, Masato, Kawamura, Taichi, Sato, Izumi, Kawakami, Koji
• Format: Article
• Language: English
• Subjects: Adult; adults; Aged; Confidence intervals; Data processing; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetic ketoacidosis; Diabetic Ketoacidosis - epidemiology; Diabetic Ketoacidosis - etiology; Female; Follow-Up Studies; Glucose; Hospitalization - statistics & numerical data; Humans; Hypoglycemic Agents - therapeutic use; Incidence; Inhibitors; Insurance Claim Review - statistics & numerical data; Japan - epidemiology; Ketoacidosis; Male; medical claims data; Middle Aged; Patients; pharmacoepidemiology; population‐based incidence; Sodium; Sodium-glucose cotransporter; Studies; type 2 diabetes
• ISSN: 1053-8569; 1099-1557
• DOI: 10.1002/pds.4271

Purpose Determination of the incidence rate of diabetic ketoacidosis (DKA) in type 2 diabetes mellitus (T2DM) is urgent, in response to the safety issue with use of the glucose lowering drugs, sodium‐glucose cotransporter‐2 inhibitors, and DKA. Methods We extracted data of adult patients with T2DM from a medical claims database in Japan, which included 1 million individuals. The study period was 2005–2013, before the era of sodium‐glucose cotransporter‐2 inhibitors. The inclusion criteria were patients with a diagnosis of T2DM who had at least 1 prescription for a glucose‐lowering drug. We further examined the number of DKA‐related admissions and medication use prior to admission. Calculation of DKA incidence was on a patient‐years basis, with 95% confidence interval using a Poisson distribution. Results Of 36,674 adult patients with T2DM, we identified 74 cases admitted for DKA, with an estimated DKA incidence of 0.48/1000 (95% confidence interval, 0.38–0.60/1000) patient‐years. Of these 74 cases, approximately two‐thirds of patients had no past or recent history of glucose‐lowering drug use before admission for DKA. Conclusions This study estimated that the incidence of DKA was 0.48/1000 patient‐years in Japan, similar to previous studies. We also found that underuse of glucose‐lowering medication was common among patients hospitalized for DKA. KEY POINTS The population‐based incidence of DKA in T2DM is largely unknown. In Japan, the estimated DKA incidence was 0.48/1000 (95% CI, 0.38–0.60/1000) patient‐years. Drug‐induced DKA is an emerging research area, and our results can be applied to evaluating the risk of DKA.