- Pancreatic cancer disrupts islet cell function producing pancreatogenic diabetes, which may precipitate diabetic ketoacidosis (DKA). No national study has characterized DKA prevalence or outcomes among pancreatic cancer hospitalizations. We aimed to address this gap using the National Inpatient Sample (NIS).

- We analyzed using NIS 2021–2023. Adult pancreatic cancer hospitalizations (ICD-10-CM C25) were stratified by concurrent DKA (E08.1–E13.1). The primary outcome was in-hospital mortality. Secondary outcomes included acute kidney injury (AKI), mechanical ventilation, septic shock, cardiac arrest, ICU, venous thromboembolism, palliative care consultation, length of stay, and total charges. Multivariable logistic regression adjusted for age, sex, race/ethnicity, income quartile, primary payer, Elixhauser comorbidity category, DM type, and hospital characteristics.

- Of 218,815 pancreatic cancer hospitalizations, 0.95% (n ≈ 2,075) had concurrent DKA. 86.3% had Type 2 DM, while fewer than 2% had type 3c DM. DKA patients were younger, more likely Black (21.9% vs. 14.2%), and had higher comorbidity burden. After multivariable adjustment, DKA independently predicted mortality (aOR 1.76, 95% CI 1.30–2.38), AKI (aOR 3.09, 95% CI 2.49–3.83), mechanical ventilation (aOR 2.78, 95% CI 1.92–4.03), ICU (aOR 2.49, 95% CI 1.90–3.27), septic shock (aOR 2.53, 95% CI 1.86–3.43), and cardiac arrest (aOR 2.40, 95% CI 1.33–4.34).

- DKA complicates approximately 1% of US pancreatic cancer hospitalizations and independently predicts doubled mortality and markedly greater critical care utilization. Black patients and lower socioeconomic groups are disproportionately affected, identifying high-risk subgroups for targeted glycemic surveillance.