Diabetic ketoacidosis (DKA) management is especially difficult in patients with comorbid cardiovascular disease (CVD), suggests a new large-scale US study. Investigators used national hospitalization data from 2016 to 2022 and determined that close to 17% of patients hospitalized with DKA had CVD—a comorbidity that significantly deteriorated clinical outcomes and elevated healthcare expenditures.

The mortality rates were greater than five times among CVD patients (1.6% compared to 0.3%), with arrhythmias and pulmonary hypertension being associated with the highest risk. Arrhythmias, especially atrial fibrillation, were significantly related to death and complications, probably because of stress hormone activation, endothelial dysfunction, and deteriorating insulin resistance.

The research identified that the patients with DKA and CVD had more multi-organ complications, such as respiratory failure, sepsis, and thromboembolic complications. These complications also led to increased hospital lengths of stay and intensive care utilization. The DKA patients with CVD, on average, spent a day more in the hospital and incurred close to $13,000 in additional healthcare expenditure.

The results were consistent in both type 1 and type 2 diabetes patients, although the side effects occurred more significantly in type 2 diabetic patients. Notably, the research also established that DKA patients with CVD had poorer outcomes compared with HHS or non-DKA admissions, highlighting the enormous burden of this dual diagnosis.

Researchers highlighted the importance of proactive control of glycemia and intensive cardiac monitoring to avoid DKA in diabetics and patients with CVD. Prompt detection and multidisciplinary care could minimize complications, expenses, and mortality among this high-risk population.