Diabetic ketoacidosis in Denmark Incidence and mortality estimated from public health registries Otto M. Henriksen a,b, * , Michael E. Røder a , Julie B. Prahl c , Ole Lander Svendsen a a Endocrine Section, Department of Internal Medicine I, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark b Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark c Paediatric Department, University Hospital Gentofte, Niels Andersen Vej 65, 2900 Hellerup, Denmark Received 31 March 2006; accepted 28 July 2006 Available online 7 September 2006 Abstract The aims of this study were to estimate incidence of diabetic ketoacidosis and mortality from diabetic ketoacidosis using data from public health registries. Four thousand eight hundred and seven admissions in the period 1996–2002 and 137 deaths in the period 1996–2000 with a diagnosis of diabetic ketoacidosis were identified from the Danish National Patient Registry and Danish Cause of Death Registry, respectively. Annual incidence of diabetic ketoacidosis in the general population was estimated to 12.9 per 100,000, being higher in males than in females (14.4 versus 11.4 per 100,000, p < 0.0001). Twelve percent of all patients were classified as Type 2 diabetes, predominantly in patients >50 years. Overall mortality was 4%, being higher in patients >70 years than in patients 70 years (15% versus 2%, p < 0.0001). One or more additional somatic diagnoses were stated on 77% of the death certificates, most often a diagnosis of cardiovascular (47%) or infectious (30%) diseases. Compared to previous studies, the incidence in the general population seems to have remained unaltered the past 25 years, but may have decreased in younger patients. Older patients with diabetic ketoacidosis differed from younger patients in having a higher mortality and a larger proportion of patients classified as Type 2 diabetes. # 2006 Elsevier Ireland Ltd. All rights reserved. Keywords: Ketoacidosis; Complications; Epidemiology 1. Introduction Diabetic ketoacidosis (DKA) is a serious metabolic emergency in diabetes. Although mortality has decreased significantly, DKA is still the most frequent cause of death in children and adolescents with diabetes [1,2]. Previous Danish studies of DKA have reported a more than three fold increase in the incidence of DKA in the general population from 1960 to 1979 [3]. Also, the prevalence of Type 1 DM in Denmark has continuously increased by over 1% per year, as a result of both increased incidence and decreased mortality [4]. Whereas the management of DKA has changed little in the past 25 years, new principles of daily insulin www.elsevier.com/locate/diabres Diabetes Research and Clinical Practice 76 (2007) 51–56 * Corresponding author at: Department of Clinical Physiology and Nuclear Medicine, University Hospital Glostrup, Ndr. Ringvej, DK- 2600 Glostrup, Denmark. Tel.: +45 4323 2433; fax: +45 4323 3928. E-mail address: omh@dadlnet.dk (O.M. Henriksen). 0168-8227/$ – see front matter # 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.diabres.2006.07.024