OBJECTIVE Diabetes is one of the most common chronic diseases and a leading cause of morbidity and mortality in the U.S. Although our ability to treat diabetes and its associated complications has significantly improved, presentation with uncontrolled diabetes leading to ketoacidosis remains a significant problem.

RESEARCH DESIGN AND METHODS We aimed to determine the incidence and costs of hospital admissions associated with diabetic ketoacidosis (DKA). We reviewed the National Inpatient Sample database for all hospitalizations in which DKA (ICD-9 codes 250.10, 250.11, 250.12, and 250.13) was the principal discharge diagnosis during 2003–2014 and calculated the population incidence by using U.S. census data. Patients with ICD-9 codes for diabetic coma were excluded because the codes do not distinguish between hypoglycemic and DKA-related coma. We then analyzed changes in temporal trends of incidence, length of stay, costs, and in-hospital mortality by using the Cochrane-Armitage test.

RESULTS There were 1,760,101 primary admissions for DKA during the study period. In-hospital mortality for the cohort was 0.4% (n = 7,031). The total number of hospital discharges with the principal diagnosis of DKA increased from 118,808 in 2003 to 188,965 in 2014 (P < 0.0001). The length of stay significantly decreased from an average of 3.64 days in 2003 to 3.24 days in 2014 (P < 0.01). During this period, the mean hospital charges increased significantly from $18,987 (after adjusting for inflation) per admission in 2003 to $26,566 per admission in 2014. The resulting aggregate charges (i.e., national bill) for diabetes with ketoacidosis increased dramatically from $2.2 billion (after adjusting for inflation) in 2003 to $ 5.1 billion in 2014 (P < 0.001). However, there was a significant reduction in mortality from 611 (0.51%) in 2003 to 620 (0.3%) in 2014 (P < 0.01).

CONCLUSIONS Our analysis shows that the population incidence for DKA hospitalizations in the U.S. continues to increase, but the mortality from this condition has significantly decreased, indicating advances in early diagnosis and better inpatient care. Despite decreases in the length of stay, the costs of hospitalizations have increased significantly, indicating opportunities for value-based care intervention in this vulnerable population.

目的糖尿病是美国最常见的慢性疾病之一，也是发病率和死亡率的主要原因。尽管我们治疗糖尿病及其相关并发症的能力已得到显着改善，但不受控制的糖尿病导致的酮症酸中毒仍然是一个重大问题。

研究设计和方法我们旨在确定与糖尿病性酮症酸中毒（DKA）相关的医院住院的发生率和费用。我们回顾了所有住院的国家住院样本数据库，其中以DKA（ICD-9代码250.10、250.11、250.12和250.13）为主要出院诊断，并使用美国人口普查数据计算了人口发病率。具有ICD-9糖尿病昏迷代码的患者被排除在外，因为这些代码无法区分降血糖和与DKA相关的昏迷。然后，我们使用Cochrane-Armitage检验分析了发病率，住院时间，费用和住院死亡率随时间变化的趋势。

结果在研究期间，DKA的初次入学人数为1,760,101。该队列的住院死亡率为0.4％（n = 7,031）。主要诊断为DKA的出院总人数从2003年的118,808人增加到2014年的188,965人（P <0.0001）。住院时间从2003年的平均3.64天显着减少到2014年的3.24天（P <0.01）。在此期间，平均住院费用从2003年的每次入院18,987美元（扣除通货膨胀因素后）显着增加到2014年的每次入院26,566美元。由此产生的患有酮症酸中毒的糖尿病的总费用（即国家费用）从22亿美元（净收入）大幅增加。调整通货膨胀率）从2003年的51亿美元增加到2014年的51亿美元（P <0.001）。但是，死亡率从2003年的611（0.51％）显着降低到2014年的620（0.3％）（P <0.01）。

结论我们的分析表明，美国DKA住院患者的发病率继续增加，但是这种情况导致的死亡率显着降低，这表明早期诊断和更好的住院治疗取得了进步。尽管住院时间缩短了，但住院费用却大大增加了，这表明在这一脆弱人群中有机会进行基于价值的护理干预。