Introduction

Diabetic ketoacidosis (DKA) prevalence and related costs continue to rise in the United States. Despite low mortality for most uncomplicated cases, DKA often prompts admission to intensive care units (ICUs), stressing limited critical care capacity. National trends in ICU utilization for DKA are not well described.

Methods

Using the National Hospital Ambulatory Medical Care Survey (NHAMCS), we analyzed adult (>18 years) emergency department (ED) visits with a DKA diagnosis from 2012–2022 were identified via ICD‐9 (249.1, 250.1) and ICD‐10 (E08.1, E09.1, E10.1, E11.1, E13.1) codes. Outcomes included annual counts of ED visits, hospitalizations, ICU admissions, and ED discharges, plus corresponding rates using DKA ED visits as the denominator. Survey weights, clustering, and strata were applied; domain analyses preserved survey design. Analyses used SAS 9.4.

Results

Among 1,531,254,405 ED visits (222,175 records), 1,935,488 visits (279 records; 0.13%) involved adult DKA. ICU admissions for DKA increased with a mean annual percentage change (MAPC) of 17.4%. ED visits, hospitalizations, and ED discharges for DKA increased with MAPCs of 18.6%, 21.0%, and 120.4%, respectively. Proportions among DKA visits were stable: ICU admission rate mean 39.9% (slope 0.03%), hospitalization rate mean 81.0% (slope 0.51%), and ED discharge rate mean 15.5% (slope −0.76%). Median ICU length of stay (LOS) for DKA was 3.22 days (IQR 1.76–5.00); 177,696 (23.4%) ICU stays were <48 hours.

Conclusions

From 2012–2022, national ICU utilization for DKA increased substantially while the proportion of DKA ED visits admitted to ICU remained unchanged, suggesting stable severity distribution and influential local practice patterns. With over one‐fifth of ICU admissions being short stay, opportunities exist to safely manage selected mild‐to‐moderate DKA outside the ICU (e.g., step‐down or ED‐ICU), which could relieve ICU strain and reduce costs.

Figures and Tables

Figure 1. National trends in emergency department encounters and disposition for diabetic ketoacidosis.

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