1334-P: Prognostic Implications of Diabetic Ketoacidosis on Long-Term Mortality and Diabetes-Related Complications
Authors: BUDHRAM DALTON R. , BAPAT PRIYA , BAKHSH ABDULMOHSEN M.K. , ABUABAT MOHAMMAD I. , VERHOEFF NATASHA , MUMFORD DOUG , ORSZAG ANDREJ , JAIN AKSHAY B. , FRALICK MICHAEL , WEISMAN ALANNA , ERIK LOVBLOM LEIF , PERKINS BRUCE A. 
Published: June 2024

Introduction & Objective: Diabetic ketoacidosis (DKA) occurring after diabetes diagnosis is often associated with risk factors for other diabetes-related complications. We aimed to determine the prognostic implications of DKA on mortality and complications in type 1 diabetes (T1D).
Methods: Previously collected data from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study was obtained through the NIDDK central repository. Using Cox proportional-hazards models with time-dependent covariates, we examined age- and sex-, HbA1c-, and fully-adjusted associations of DKA with mortality, cardiovascular disease, microvascular, and acute complications over 34 years.
Results: Of 1441 participants, 297 (20.6%) had 488 DKA events. DKA after diabetes diagnosis was associated with a higher risk of age- and sex-adjusted mortality [hazard ratio (HR) 8.28, 95% confidence interval (CI) 3.74-18.32, p&lt;0.001], major adverse cardiovascular events (HR 2.05, 95% CI 1.34-3.13, p&lt;0.001), and all advanced microvascular and acute complications compared to no DKA after diabetes diagnosis. Most associations were significant even after adjustment for covariates. The cumulative incidence and hazard estimates for someone exposed to DKA compared to unexposed were greater for mortality (6.0% vs. 1.3%), major adverse cardiovascular events (12.3% vs. 6.5%), advanced neuropathy (23.1% vs. 14.4%), advanced nephropathy (6.8% vs. 2.2%), advanced retinopathy (51.9% vs. 43.7%), severe hypoglycemia (6 events vs. 5 events), and recurrent DKA (1 event vs. 0 events).
Conclusions: DKA is a prognostic marker for diabetes complications, including excess mortality. Intensified clinical interventions, such as enhanced self-management education, glycemic control, and cardiovascular prevention strategies may be warranted following the diagnosis of DKA.

Disclosure
D.R. Budhram: None. P. Bapat: None. A.M.K. Bakhsh: None. M.I. Abuabat: None. N. Verhoeff: None. D. Mumford: None. A. Orszag: None. A.B. Jain: Advisory Panel; Abbott. Speaker's Bureau; Abbott. Advisory Panel; Boehringer-Ingelheim. Speaker's Bureau; Boehringer-Ingelheim. Advisory Panel; Amgen Inc. Speaker's Bureau; Amgen Inc., AstraZeneca. Advisory Panel; AstraZeneca. Speaker's Bureau; Care to Know, CCRN, Connected in Motion, CPD Network, Dexcom, Diabetes Canada, Eli Lilly, GSK, HLS Therapeutics, Janssen, Master Clinician Alliance, MDBriefcase, Merck, Medtronic, Moderna, Novartis, N. Advisory Panel; Bausch Healthcare, Bayer,, Dexcom, Eli Lilly, Gilead Sciences, GSK, HLS Therapeutics, Insulet, Janssen, Medtronic, Novo Nordisk, Partners in Progressive Medical Education, Pfizer, PocketPills, Roche,. M. Fralick: Consultant; singal1, proofdx. A. Weisman: None. L. Lovblom: None. B.A. Perkins: Advisory Panel; Abbott. Other Relationship; Novo Nordisk. Advisory Panel; Insulet Corporation, Nephris. Other Relationship; Medtronic. Advisory Panel; Sanofi, Vertex Pharmaceuticals Incorporated, Dexcom, Inc.

Funding
Diabetes Canada (Operating Grant OG-3-21-5572-BP)