Psychiatric and Substance Use Disorders and Their Association With Clinical Outcomes in Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are life-threatening conditions that send nearly 180,000 patients to the intensive care unit each year, with mortality rates up to 5–10%. Little is known about the impact of concurrent psychiatric disorders on specific DKA/HHS ou...

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Bibliographic Details
Published in:Journal of the Academy of Consultation-Liaison Psychiatry 2024-09, Vol.65 (5), p.451-457
Main Authors: Leyden, Jacinta, Uber, Amy, Herrera-Escobar, Juan P., Levy-Carrick, Nomi C.
Format: Article
Language:English
Subjects:
Adult
Aged
Comorbidity
concurrent psychiatric disorder
Diabetic Ketoacidosis - epidemiology
Diabetic Ketoacidosis - mortality
Diabetic Ketoacidosis - therapy
DKA
Female
HHS
Hospitalization - statistics & numerical data
Humans
Hyperglycemic Hyperosmolar Nonketotic Coma - therapy
Male
Massachusetts - epidemiology
Mental Disorders - epidemiology
Middle Aged
Retrospective Studies
substance use
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Summary:Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are life-threatening conditions that send nearly 180,000 patients to the intensive care unit each year, with mortality rates up to 5–10%. Little is known about the impact of concurrent psychiatric disorders on specific DKA/HHS outcomes. Identifying these relationships offers opportunities to improve clinical management, treatment planning, and mitigate associated morbidity and mortality. We conducted a retrospective review including adult DKA/HHS admissions within a large Massachusetts hospital system from 2010 to 2019. We identified patients admitted inpatient for DKA or HHS, then filtered by International Classification of Disease-9-CM and International Classification of Disease-10-CM codes for psychiatric diagnoses that were present in patients electronic medical record at any point in this observational period. Outcomes included the number of inpatient admissions for DKA/HHS, age of death, rates of discharging against medical advice (AMA) from any inpatient admission, and end-stage renal disease/dialysis status. Multivariate regression was conducted using R software to control for variables across patients and evaluate relationships between outcomes and concurrent psychiatric disorders. Significance was set at P 
ISSN:2667-2960
2667-2960
DOI:10.1016/j.jaclp.2024.02.007