CLINICAL AND HEALTHCARE FACTORS ASSOCIATED WITH DIABETIC KETOACIDOSIS AT PEDIATRIC TYPE 1 DIABETES DIAGNOSIS IN THE US AND ENGLAND
Author(s)
Julia Liaw, PharmD, Kristen Lloyd, MS, Abner Nyandege, PhD, Chintan Dave, PharmD, PhD;
Rutgers University, New Brunswick, NJ, USA
Rutgers University, New Brunswick, NJ, USA
OBJECTIVES: Diabetic ketoacidosis (DKA) is a common and serious complication at the time of pediatric type 1 diabetes (T1D) diagnosis, yet the clinical, sociodemographic, and healthcare factors preceding diagnosis remain poorly characterized.
METHODS: We conducted a retrospective cohort study using U.S. Medicaid, U.S. MarketScan, and U.K. CPRD data (2002-2020), identifying children aged 6 months to 21 years with incident T1D using a validated algorithm (PPV > 94%). Children presenting with DKA at diagnosis were compared with those without DKA. DKA was defined as a DKA hospitalization within 30 days prior to T1D diagnosis Covariates in the 180 days prior (60 days for acute conditions) were evaluated using modified Poisson regression to estimate relative risks of presenting in DKA, with results pooled across data sources using fixed-effects meta-analysis.
RESULTS: Among 116,045 children with incident T1D, 48,764 (42.0%) presented with DKA. Younger age was the strongest determinant, with children <2 years having nearly twice the risk compared with adolescents (pooled RR 1.86; 95% CI 1.81, 1.91). Higher social vulnerability and Black or Hispanic race/ethnicity were also consistently associated with increased risk, and DKA incidence rose over time, peaking in 2016-2020 (RR 1.29; 95% CI 1.26, 1.32 vs 2002-2005). In the months preceding diagnosis, acute physiologic stressors such as vomiting were strongly associated with DKA (RR 1.60; 95% CI 1.57, 1.62), whereas most infection and other clinical categories showed null associations. Notably, 58.5% of children presenting with DKA had an outpatient visit within the prior 60 days, representing a missed opportunity for earlier detection.
CONCLUSIONS: DKA at T1D diagnosis was common and strongly associated with young age, social vulnerability, and recent acute physiologic stressors rather than antecedent infections or conditions. The high frequency of recent outpatient encounters highlights potential opportunities for earlier recognition and prevention of DKA.
METHODS: We conducted a retrospective cohort study using U.S. Medicaid, U.S. MarketScan, and U.K. CPRD data (2002-2020), identifying children aged 6 months to 21 years with incident T1D using a validated algorithm (PPV > 94%). Children presenting with DKA at diagnosis were compared with those without DKA. DKA was defined as a DKA hospitalization within 30 days prior to T1D diagnosis Covariates in the 180 days prior (60 days for acute conditions) were evaluated using modified Poisson regression to estimate relative risks of presenting in DKA, with results pooled across data sources using fixed-effects meta-analysis.
RESULTS: Among 116,045 children with incident T1D, 48,764 (42.0%) presented with DKA. Younger age was the strongest determinant, with children <2 years having nearly twice the risk compared with adolescents (pooled RR 1.86; 95% CI 1.81, 1.91). Higher social vulnerability and Black or Hispanic race/ethnicity were also consistently associated with increased risk, and DKA incidence rose over time, peaking in 2016-2020 (RR 1.29; 95% CI 1.26, 1.32 vs 2002-2005). In the months preceding diagnosis, acute physiologic stressors such as vomiting were strongly associated with DKA (RR 1.60; 95% CI 1.57, 1.62), whereas most infection and other clinical categories showed null associations. Notably, 58.5% of children presenting with DKA had an outpatient visit within the prior 60 days, representing a missed opportunity for earlier detection.
CONCLUSIONS: DKA at T1D diagnosis was common and strongly associated with young age, social vulnerability, and recent acute physiologic stressors rather than antecedent infections or conditions. The high frequency of recent outpatient encounters highlights potential opportunities for earlier recognition and prevention of DKA.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH51
Topic
Epidemiology & Public Health
Topic Subcategory
Public Health
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity), SDC: Pediatrics