The effect of deprivation and HbA1c on admission to hospital for diabetic ketoacidosis in type 1 diabetes

• Published in: Diabetologia 2012-09, Vol.55 (9), p.2356-2360
• Main Authors: Govan, L., Maietti, E., Torsney, B., Wu, O., Briggs, A., Colhoun, H. M., Fischbacher, C. M., Leese, G. P., McKnight, J. A., Morris, A. D., Sattar, N., Wild, S. H., Lindsay, R. S.
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Blood Glucose - metabolism; Data Collection; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - epidemiology; Diabetes. Impaired glucose tolerance; Diabetic Ketoacidosis - blood; Diabetic Ketoacidosis - epidemiology; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Glycated Hemoglobin - metabolism; Human Physiology; Humans; Internal Medicine; Male; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Patient Admission - statistics & numerical data; Registries - statistics & numerical data; Risk Factors; Scotland - epidemiology; Short Communication; Smoking - blood; Smoking - epidemiology; Socioeconomic Factors; Young Adult
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-012-2601-6

Aims/hypothesis Diabetic ketoacidosis is a potentially life-threatening complication of diabetes and has a strong relationship with HbA 1c . We examined how socioeconomic group affects the likelihood of admission to hospital for diabetic ketoacidosis. Methods The Scottish Care Information – Diabetes Collaboration (SCI-DC), a dynamic national register of all cases of diagnosed diabetes in Scotland, was linked to national data on hospital admissions. We identified 24,750 people with type 1 diabetes between January 2005 and December 2007. We assessed the relationship between HbA 1c and quintiles of deprivation with hospital admissions for diabetic ketoacidosis in people with type 1 diabetes adjusting for patient characteristics. Results We identified 23,479 people with type 1 diabetes who had complete recording of covariates. Deprivation had a substantial effect on odds of admission to hospital for diabetic ketoacidosis (OR 4.51, 95% CI 3.73, 5.46 in the most deprived quintile compared with the least deprived). This effect persisted after the inclusion of HbA 1c and other risk factors (OR 2.81, 95% CI 2.32, 3.39). Men had a reduced risk of admission to hospital for diabetic ketoacidosis (OR 0.71, 95% CI 0.63, 0.79) and those with a history of smoking had increased odds of admission to hospital for diabetic ketoacidosis by a factor of 1.55 (95% CI 1.36, 1.78). Conclusions/interpretation Women, smokers, those with high HbA 1c and those living in more deprived areas have an increased risk of admission to hospital for diabetic ketoacidosis. The effect of deprivation was present even after inclusion of other risk factors. This work highlights that those in poorer areas of the community with high HbA 1c represent a group who might be usefully supported to try to reduce hospital admissions.