American Diabetes Association
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Diabetic Ketoacidosis and Mortality in People With Type 1 Diabetes and Eating Disorders

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posted on 2021-06-25, 15:19 authored by Nicole K. Gibbings, Paul A. Kurdyak, Patricia A. Colton, Baiju R. Shah
Objective: To determine the risk of diabetic ketoacidosis (DKA) and all-cause mortality among adolescents and young adults with type 1 diabetes with and without an eating disorder.

Research Design and Methods: Using population-level healthcare administrative data covering the entire population of Ontario, Canada, all people with type 1 diabetes aged 10 to 39 as of January 2014 were identified. Individuals with a history of eating disorders were age/sex matched 10:1 with individuals without eating disorders. All individuals were followed for 6 years for hospitalization/emergency department visits for diabetic ketoacidosis, and for all-cause mortality.

Results: We studied 168 people with eating disorders and 1680 age/sex-matched people without eating disorders. Among adolescents and young adults with type 1 diabetes, 168 (0.8%) had a history of eating disorders. The crude incidence of diabetic ketoacidosis was 112.5 per 1,000 patient-years in people with eating disorders, versus 30.8 in people without eating disorders. After adjustment for baseline differences, the subdistribution hazard ratio comparing people with and without eating disorders was 3.30 (95% confidence interval 2.58-4.23, p<0.0001). All-cause mortality was 16.0 per 1,000 person-years in people with eating disorders, versus 2.5 in people without eating disorders. The adjusted hazard ratio was 5.80 (95% confidence interval 3.04-11.08, p<0.0001).

Conclusions: Adolescents and young adults with type 1 diabetes and eating disorders have more than triple the risk of diabetic ketoacidosis and nearly 6-fold increased risk of death compared to their peers without eating disorders.


This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and the Ministry of Long-Term Care. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information. The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred.


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