Association of doctor specialty with diabetic patient risk of hospitalization due to diabetic ketoacidosis: A national population-based study in Taiwan

Objectives Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, and its risks can be largely reduced by adequate and high-quality ambulatory diabetic care. The aim of this study is to assess the risk and frequency of developing DKA in relation to the specialty of doctors who provide diabetes cares. Methods In searching for possible episodes of hospitalization due to DKA (ICD-9-CM: 250.1), we used a prospective cohort design in which 500 867 diabetic patients identified in the 1997 National Health Insurance (NHI) ambulatory care data set of Taiwan were linked to the 1997-2006 NHI inpatient claims data. The study subjects were categorized into four groups according to doctor specialty. A logistic regression model was used to assess the risk and frequency of DKA admission in relation to doctor's specialty. Results Compared with the patients routinely cared by endocrinologists, those not consistently cared by endocrinologists had significantly increased odds ratios (ORs) of DKA admission, ranging between 1.51 and 2.12. Moreover, the adjusted OR of the higher DKA admission frequency (≥0.133 times/person-year) for the patients not regularly cared by endocrinologists was also significantly increased, between 4.45 and 6.93. Conclusions Doctor specialty significantly influenced the risk and frequency of DKA admission in diabetes patients in Taiwan. Local health care administrators and policy makers should therefore consider promoting the quality of diabetes care provided by non- endocrinologists.