Hospitalizations for diabetic ketoacidosis (DKA) continue to increase despite therapeutic advances in type 1 diabetes mellitus (T1DM). A retrospective cohort study published in BMJ Open Diabetes Research & Care evaluated whether age and sex were associated with differences in in-hospital mortality, acute complications, and resource utilization among adults with T1DM hospitalized for DKA.

Using the National Inpatient Sample (NIS) from 2016 to 2021, the analysis identified adult hospitalizations for DKA in T1DM and stratified them into three age groups: 18-44, 45-64, and ≥65 years. Multivariable logistic regression models adjusted for patient and hospital characteristics assessed associations between sex and in-hospital mortality (primary outcome), as well as acute kidney injury (AKI) and sepsis.

Across all age groups, female sex was independently associated with lower odds of AKI (adjusted odds ratio [aOR] 0.56 in ages 18-44; 0.71 in 45-64; and 0.79 in ≥65 years; p < 0.05) but higher odds of sepsis (aOR 1.66, 1.31, and 1.17, respectively; p < 0.05). Among young adults aged 18-44 years, women had lower adjusted odds of in-hospital mortality (aOR 0.72; 95% confidence interval [CI] 0.60-0.86). This mortality difference was not observed in middle-aged or older adults. Mortality increased during 2020-2021 across all age–sex groups, most prominently among young men (0.48% to 0.89%).

Age and sex were closely associated with acute complications and in-hospital mortality in DKA hospitalizations.