Identifying the Healthcare Burden of Diabetic Ketoacidosis: Economic Analysis and Mitigation Strategies for Adult Patients in the United Arab Emirates

Introduction: Diabetic ketoacidosis (DKA) is a potentially fatal diabetes complication marked by hyperglycemia, ketonemia, and acidosis that remains a major global healthcare burden despite advances in diabetes management. The aim of this study was to quantify the healthcare costs of DKA admissions at a tertiary hospital in the United Arab Emirates (UAE), and evaluate cost-effective preventative strategies. Methods: A retrospective electronic record analysis of all DKA admissions from 2019 to 2023 at Tawam Hospital, Al Ain, was conducted after ethical approval from Tawam Human Research Ethics Committee, approval number MF2058-2023-916. Clinical characteristics, precipitating factors, length of stay, insurance status, and total inpatient costs were analyzed for all consecutive adult (≥ 16 years) DKA admissions over this period. The cost of DKA-related admission was compared to the price of insulin therapy in underinsured patients who are unable to afford insulin. Results: There were 134 patients admitted with DKA (157 admissions) over 5 years (one DKA admission every 11.6 days). The mean hospitalization cost per DKA admission was 12,274 ± 10,213 USD (45,461 ± 37,826 AED), with an average length of stay of 10.2 ± 11.7 days (1203 USD [4,457 AED] per day). Insulin unaffordability, a preventable factor, led to 13.4% (21 cases) of admissions, incurring a total cost of 257,765 USD (954,686 AED). Underinsured patients demonstrated significantly higher ICU utilization (76.8% vs 52.5%, p < 0.01) and mean costs (14,269 USD [52,847 AED] vs 11,133 USD [41,235 AED], p = 0.07) compared to adequately insured patients. In comparison, the average cost of insulin is 38 USD (139.5 AED) per patient/month, indicating that the cost of one preventable DKA admission equals 27 years of insulin therapy. The overall mortality rate of DKA admissions was 4.5%. Conclusion: DKA imposes a substantial economic and clinical burden in the UAE, with mean hospitalization costs of 12,274 USD per admission. While insulin unaffordability accounts for 13.4% of admissions (costing 257,765 over 5 years), infections represent the largest precipitating factor at 49.0%. Comprehensive DKA prevention requires a multifaceted approach: infection management education, ensuring insulin access for underinsured patients, and structured diabetes education. Our analysis suggests that addressing insulin affordability could be economically favorable, as preventing one DKA admission would offset 27 years of insulin costs. However, optimal resource allocation requires addressing all major precipitating factors to achieve meaningful reductions in DKA burden.