MON-564 - Factors Associated with in-Hospital Mortality for Patients with Type 1 Diabetes Mellitus

Background: Adults with Type 1 diabetes mellitus (DM1) experience frequent hospitalizations and remain at risk for significant inpatient morbidity and mortality. Contemporary national data evaluating predictors of in-hospital death in this population are limited.

Methods: We performed a retrospective analysis of the National Inpatient Sample (NIS) database from 2016–2022 to identify adult hospitalizations with DM1. Baseline demographics, comorbidities, and hospital characteristics were compared between patients discharged alive and those with in-hospital mortality. Variables with p≤0.20 on univariable analysis were entered into a multivariable logistic regression model to identify independent predictors of in-hospital death. Statistical significance was defined as p≤0.05.

Results: A total of 2,500,824 DM1 hospitalizations were analyzed, including 35,860 in-hospital deaths (1.4%). Patients who died were older (median age 60 vs. 41 years, p< 0.001), more often male (53.9% vs. 48.2%, p< 0.001), more often White (67.2% vs. 62.5%, p< 0.001), less often African American (15.7% vs. 20.3%, p< 0.001) and less often Hispanic (8.9% vs. 10.2%, p< 0.001). Deceased patients experienced longer hospitalizations (5 vs. 3 days, p< 0.001) with nearly threefold higher median charges ($89,140 vs. $30,561, p< 0.001).
In multivariable analysis, independent predictors of in-hospital death included age (OR 1.03 per year; 95% CI 1.025–1.029), arrhythmias (OR 1.88; 95% CI 1.759–2.009), cancer (OR 1.84; 95% CI 1.685–2.018), cerebrovascular accident (OR 2.97; 95% CI 2.612–3.379), chronic kidney disease (OR 1.25; 95% CI 1.178–1.328), COVID-19 infection (OR 1.88; 95% CI 1.717–2.056), myocardial infarction (OR 1.82; 95% CI 1.684–1.971), necrotizing fasciitis (OR 1.92; 95% CI 1.417–2.603), liver disease (OR 4.51; 95% CI 4.113–4.940), sepsis (OR 2.92; 95% CI 2.750–3.103), venous thromboembolism (OR 1.63; 95% CI 1.419–1.864), and respiratory failure (OR 13.26; 95% CI 12.41–14.18). Diabetic ketoacidosis (DKA) was not independently associated with increased in-hospital mortality after multivariable adjustment (OR 0.86; 95% CI 0.80–0.92; p< 0.001).

Conclusion: In this large national cohort, in-hospital mortality among adults with DM1 was primarily driven by age and severe systemic complications, particularly respiratory failure, sepsis, and liver disease. DKA was not an independent predictor of in-hospital mortality after multivariable adjustment, suggesting that death risk is more strongly associated with concurrent organ failure and critical illness rather than glycemic decompensation alone. These findings identify high-risk inpatient subgroups and emphasize the need for targeted management strategies to reduce mortality in DM1 hospitalizations.

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