JE. Chia, SP. Ang, S. Wu and J. Iglesias (2026). Age and sex differences in diabetic ketoacidosis outcomes in type 1 diabetes: a national cohort study. BMJ open diabetes research & care, 14(1). https://doi.org/10.1136/bmjdrc-2025-005817

PubMed 41698751

[Abstract]
BACKGROUND: Despite therapeutic advances, diabetic ketoacidosis (DKA) hospitalizations continue to increase. The role of demographic factors, including age and sex in the outcomes of DKA remains underexplored. We aimed to investigate the interaction between age and sex on clinical outcomes, resource utilization and mortality in patients with type 1 diabetes hospitalized for DKA.

METHODS: We conducted a retrospective cohort study using the National Inpatient Sample from 2016 to 2021. We identified adult hospitalizations with DKA in patients with type 1 diabetes, stratified into three age groups: 18-44, 45-64 and ≥65 years. Multivariable logistic regression models were used to analyze the association between sex and the primary outcome of in-hospital mortality, and secondary outcomes including acute kidney injury (AKI) and sepsis, adjusting for patient and hospital characteristics.

RESULTS: Across all age groups, female sex was independently associated with significantly lower odds of AKI (aOR 0.56 in ages 18-44; 0.71 in 45-64; 0.79 in ≥65) but higher odds of sepsis (aOR 1.66, 1.31 and 1.17, respectively; all p<0.05). In young adults (18-44), women had significantly lower adjusted odds of mortality (aOR 0.72, 95% CI 0.60 to 0.86). This mortality benefit was not observed in middle-aged or older adults. Prepandemic (2016-2019), mortality trends diverged by sex and age, with rates increasing for young men but decreasing for young women. The pandemic (2020-2021) precipitated a sharp mortality increase across all age-sex groups, most dramatically in young men (from 0.48% to 0.89%).

CONCLUSION: Our study showed that age and sex were closely linked to acute complications and in-hospital death. Women had lower odds of AKI but higher odds of sepsis than men, with a survival advantage limited to young adults, and mortality rose during the COVID-19 years for both sexes, especially in young men.