Impact of Obesity on Outcomes of Diabetic Ketoacidosis—Results from the National Inpatient Sample

Introduction: Obesity is associated with better outcomes in patients with myocardial infarction and sepsis among other conditions a phenomena being described as obesity paradox. The impact of obesity and morbid obesity in DKA is not well studied.

Objective: To estimate the impact of obesity and morbid obesity on in-hospital mortality in patients hospitalized for diabetic ketoacidosis (DKA).

Methods: Data from the National Inpatient Sample (NIS) for the years 2012 to 2014, Health Care Utilization Project were reviewed. Patients with a diagnosis of DKA were included using the relevant ICD 9 codes. The primary outcome measured was in-hospital mortality. The Odds Ratio (OR) adjusted for age, gender, Charlson index and sepsis was calculated for obesity and morbid obesity respectively.

Results: A total of 4,468,339 individuals with a diagnosis of DM were reviewed in this retrospective study. 132,362 patients (2.96%), who had a diagnosis of DKA were included. In patients with DKA, obesity (BMI 30-40) was present in 7,635 (5.77%). Morbid obesity was present in 5,290 (4%). Mortality was 1.8% vs. 1.9%, p=0.65 in patients with obesity and (3.5% vs. 1.9%, p<0.001) in patients with morbid obesity. In multiple logistic regression and after adjustment to age, gender, Charlson index and sepsis, morbid obesity was associated with increased OR for mortality: 1.37 (95% CI, 1.18-1.61).

Conclusion: In patients with DKA, morbid obesity was associated with increased mortality. A BMI of (30-40) was not associated with increased mortality. No protective effect of obesity or morbid obesity (obesity paradox) was observed in our study.