2988-LB: Rising Burden and Increased Mortality of Type 2 Diabetes–Related Diabetic Ketoacidosis: A National Inpatient Analysis, 2018–2022

Introduction and Objective: Diabetic ketoacidosis (DKA) has been considered a complication of T1D; however, evolving diabetes epidemiology, treatment and rising obesity may be altering its clinical profile. Contemporary national data comparing trends and outcomes of T1D versus T2D related DKA are limited. Methods: We identified adult DKA hospitalizations in the 2018-2022 National Inpatient Sample using ICD-10-CM codes and stratified cases by diabetes type. Survey-weighted analyses produced national estimates. Multivariable Logistic regression assessed mortality and complications, and linear regression evaluated LOS and charges, adjusting for demographics, comorbidities, hospital factors, and year. Results: Among 1. 14 million weighted DKA hospitalizations, the proportion attributable to T2D increased from 37. 97% in 2018 to 43. 17% in 2022 (P0. 001). T2D DKA had two-fold higher odds of in hospital mortality (aOR 2. 04, 95% CI 1. 74-2. 40), greater odds of sepsis (1. 14) and need for mechanical ventilation (1. 10) but lower odds of acute kidney injury (0. 92) and shock (0. 82). Resource utilization was also higher with longer LOS (adjusted β 0. 25 days) and ~3, 993 higher hospitalization costs (all P0. 001). Conclusion: T2D accounts for a growing share of DKA hospitalizations and is linked to higher mortality and resource use than T1D DKA, indicating a shift in DKA phenotype and need for better risk stratification in T2D patients. Disclosure R. Degef: None. M. Wossene: None. M. Y. Berhane: None. T. Dagnachew: None. M. Ionescu: None.