Temporal variation of diabetic ketoacidosis and hypoglycemia in adults with type 1 diabetes: A nationwide cohort study

BackgroundSeasonality in health outcomes has long been recognized for conditions such as colds and flus. The aim of the present study was to determine whether hospitalizations for acute complications of type 1 diabetes (T1D) vary by month and season. MethodsAn observational study was performed of national administrative health data. Hospitalizations for acute complications in adults (aged 18 years) with T1D were identified using ICD-10 (Canadian revision) codes between 2004 and 2010. Monthly and seasonal counts per year were determined for the study period. For each acute complication, the ratio of the number of observed hospitalizations/expected number of hospitalizations was calculated for each month and season per year, adjusting for varied lengths of month, season, and year. ResultsIn all, there were 21 568 hospitalizations for diabetic ketoacidosis (DKA) and 5349 hospitalizations for hypoglycemia during the study period. December had higher than expected hospitalizations for DKA and March had higher than expected hospitalizations for hypoglycemia. There did not appear to be variation for either DKA or hypoglycemia hospitalizations by season. ConclusionsThe results of the present study suggest temporal variation in hospitalizations for DKA and hypoglycemia, and therefore signal important times of patient vulnerability. Potential mechanisms underlying this pattern warrant further examination. Prevention strategies and resources for patients with T1D may need to be increased at specific times during the year.