W. Liang, H. Yu, H. Deng, J. Chen, Y. Cheng, Z. Xu, Y. Li, et al. (2026). Diabetic ketoacidosis and hyperosmolar hyperglycemic state in type 2 diabetes patients with severe kidney disease: a 7-year retrospective analysis. Journal of diabetes and its complications, 40(2), 109253. https://doi.org/10.1016/j.jdiacomp.2025.109253

PubMed 41422629

[Abstract]
BACKGROUND: Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) represent two critical, acute hyperglycemic emergencies that can occur in individuals with diabetes. This study specifically aims to evaluate the in-hospital outcomes of DKA and HHS among patients with type 2 diabetes (T2D) who have severe kidney disease.

METHODS: We analyzed data from the National Inpatient Sample (2016-2022) to classify adults with T2D and severe kidney disease into three groups: DKA, HHS, and neither. We looked at in-hospital mortality as the primary outcome and assessed complications, length of stay (LOS), and hospitalization costs as secondary outcomes.

RESULTS: A total of 4773 admissions had DKA, 2179 had HHS, and 683,079 had neither. DKA was associated with significantly worse outcomes, including higher in-hospital mortality, increased rates of complications, as well as longer hospital stays and higher costs compared to those without DKA or HHS. HHS showed smaller and less consistent differences compared to non-DKA/HHS. It was associated with increased risks of neurologic events, septic shock, and the need for mechanical ventilation. Direct comparison confirmed that DKA imposed a substantially greater clinical and economic burden than HHS.

CONCLUSIONS: DKA poses a significantly greater risk of in-hospital mortality and complications in T2D with severe kidney disease. This highlights the critical need for targeted prevention and management strategies for DKA in this vulnerable population.