Abstract Background/Introduction Diabetes-related emergencies—including Diabetic Ketoacidosis (DKA), Hyperosmolar Hyperglycaemic State (HHS), and severe hypoglycaemia—are associated with substantial morbidity, prolonged hospitalisation, and increased mortality. While disparities in chronic diabetes outcomes by ethnicity are well established, their influence during acute inpatient episodes remains underexplored. Addressing these disparities is crucial to ensuring equitable care delivery and informing national strategies. Purpose This study aimed to: (i) characterise ethnic differences in presentation, management, and outcomes of DKA, HHS, and hypoglycaemia; and (ii) evaluate whether ethnicity independently predicts episode duration, length of stay (LOS), and in-hospital mortality. Methods We conducted a retrospective multicentre cohort study using the DEKODE (Digital Evaluation of Ketosis and Other Diabetes-related Emergencies) surveillance system. Adults (≥16 years) admitted with DKA, HHS, or severe hypoglycaemia between January 2020 and December 2023 were included. Patients were categorised as White, Asian, or Black using NHS ethnicity codes. Demographic, clinical, and biochemical data were analysed. Multivariable regression was used to assess the associations between ethnicity and outcomes, adjusting for age, sex, diabetes type, the Charlson Comorbidity Index, and key biochemistry parameters. Results Among 4,257 DKA episodes, Black and Asian patients were younger, more likely to have type 2 diabetes, and had higher glucose levels. A new diabetes diagnosis was more common in Black patients (21%) during the index admission. Black ethnicity was associated with longer DKA duration (p=0.006); both Black and Asian patients had longer LOS (p0.01). In 191 HHS episodes, Asian patients had higher osmolality, required more intensive treatment, and had longer LOS (p=0.014). Adjusted odds of mortality were lower for Asian patients (aOR=0.07, p=0.002); mortality was highest in White patients (23%). Among 2,411 hypoglycaemia episodes, fasting and sulfonylurea use were more common in Asian and Black patients. Black ethnicity was associated with lower mortality (aOR=0.43, p=0.037); female gender (aOR=1.55, p=0.027) and type 2 diabetes (aOR=4.7, p0.001) were linked to higher risk. Conclusion(s) Ethnicity independently influences outcomes in diabetic emergencies. These findings underscore that tailored, equity-focused care pathways are essential to improving acute diabetes care
Philip et al. (Mon,) studied this question.