Treatment of diabetic ketoacidosis and the weekend effect at an urban tertiary-care center

Objective: Weekend admission has been associated with higher morbidity and mortality, but the relationship between diabetic ketoacidosis (DKA) outcomes and this weekend effect is unclear. To better characterize it, we examined the outcomes of patients admitted with DKA to an urban tertiary-care center. Methods: This retrospective study included pediatric and adult patients admitted to Montefiore Health System from January 1, 2008, through December 31, 2018, with a primary or secondary diagnosis of DKA as identified by International Classification of Diseases (ICD)-9 and -10 codes; all ICD diagnoses were present on admission. Only the first admission for each patient was analyzed, and patients were excluded if their initial anion gap was less than 13 mEq/L. A subcohort comprised of patients with documented biochemical evidence of DKA resolution was also analyzed. The Friday-Saturday weekend was defined as the period between midnight on Friday and midnight on Sunday; the Saturday-Sunday weekend was similarly defined. The following outcomes were compared between weekday and weekend groups: length of stay; time to initiation of subcutaneous insulin; and time to each of the following: venous pH >7.3, blood glucose <200 mg/dL, and anion gap ≤12 mEq/L. Odds of 30-day all-cause mortality and 30-day all-cause and DKA-specific readmission were also examined. Results: Over 11 years, 4,703 patients were included in the overall cohort, and 648 were included in the subcohort. For both weekend definitions, weekend admission did not produce differences in any outcome for either study cohort. Conclusion: No weekend effect on DKA outcomes was detected at an urban tertiary-care center.