Diabetic ketoacidosis and hyperosmolar hyperglycemic state in diabetes patients with heart failure: insight from the National inpatient sample

BACKGROUND: Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS) are acute, life-threatening hyperglycemic conditions in diabetes. We aim to assess in-hospital cardiovascular outcomes of DKA and HHS in type 2 diabetes (T2D) patients with heart failure (HF) and compare both complications. METHODS: The National Inpatient Sample database was used to gather data on T2D patients admitted for HF (primary diagnosis) from 2008 to 2019. The secondary diagnoses were DKA or HHS. The outcomes investigated were mortality, ischemic stroke, acute renal failure, and cardiogenic shock. RESULTS: Diabetes HF patients with DKA were younger than those without HHS-DKA, more likely to be females, and had a higher prevalence of coronary artery disease and chronic kidney disease. DKA was associated with higher adjusted risk of mortality (aOR = 2.75[2.42-3.13)], ischemic stroke (aOR = 2.51[1.80-3.49]), acute renal failure (aOR = 1.54[1.45-1.64]), and cardiogenic shock (aOR = 2.53[2.19-2.92]. Diabetes HF patients with HHS were also younger but had more comorbidities than those without HHS-DKA. However, HHS was only associated with an increased adjusted risk of acute renal failure (aOR = 1.59[1.49-1.70]. When both hyperglycemic groups were compared, DKA patients were younger and had fewer comorbidities. However, they had a higher adjusted risk of mortality (aOR = 2.90[2.22-3.79] and cardiogenic shock (aOR = 2.86 [2.13-3.83], but not acute renal failure or stroke. CONCLUSIONS: DKA and HHS are associated with worse cardiovascular outcomes in heart failure patients with type 2 diabetes. Further, when both conditions were compared, the mortality risk and cardiogenic shock were higher in DKA compared to HHS. Implementing tailored fluid and electrolyte management, optimizing insulin protocols, and enhancing monitoring with early intervention could be lifesaving for these high-risk patients.