HEALTH UTILIZATION AND ECONOMIC BURDEN OF DIABETIC KETOACIDOSIS AT TYPE 1 DIABETES DIAGNOSIS
Author(s)
Nai-Chia Chen, MS1, Eric J. Gutierrez, MPH1, Kelly E. Anderson, PhD2, G. Todd Alonso, MD3, Robert Brett McQueen, BA, MA, PhD1.
1University of Colorado Skaggs School of Pharmacy and Pharmaceutical Science, Aurora, CO, USA, 2Brigham and Women’s Hospital and Harvard Medical School, Program on Regulation, Therapeutics, and Law (PORTAL), Boston, MA, USA, 3University of Colorado Anschutz Medical Campus Barbara Davis Center, Aurora, CO, USA.
1University of Colorado Skaggs School of Pharmacy and Pharmaceutical Science, Aurora, CO, USA, 2Brigham and Women’s Hospital and Harvard Medical School, Program on Regulation, Therapeutics, and Law (PORTAL), Boston, MA, USA, 3University of Colorado Anschutz Medical Campus Barbara Davis Center, Aurora, CO, USA.
OBJECTIVES: Although diabetic ketoacidosis (DKA) remains a common and serious complication at type 1 diabetes diagnosis, population-level estimates of its associated healthcare utilization and expenditures remain limited. The study aimed to estimate geographic variation and temporal patterns in DKA at the time of type 1 diabetes diagnosis and evaluate associated healthcare utilization and expenditures using multi-state all-payer claims databases (APCDs).
METHODS: We conducted a retrospective cohort study using APCDs from Arkansas, Maryland, Oregon, and Utah in 2014-2022. Patients aged <18 years with newly identified type 1 diabetes were classified into three groups based on type 1 diabetes and DKA coding and encounter types: confirmed DKA, potential DKA, and outpatient-only diagnoses. Healthcare resource utilization and expenditures were assessed across baseline (-12 to -1 months), diagnosis (-1 to +3 months), and follow-up (+3 to +12 months) periods. Adjusted expenditures were estimated using two-part models - probit and generalized linear models with a gamma distribution and a log link. The study was funded by the Leona M. and Harry B. Helmsley Charitable Trust.
RESULTS: Among 14,120 patients with confirmed type 1 diabetes from APCDs, 2,078 (14.7%) patients had confirmed DKA and 1,545 (10.9%) patients had potential DKA. Substantial sociodemographic and geographic variations in DKA at diagnosis were observed. Patients with DKA were more likely to have Medicaid coverage and resided in areas with higher social vulnerability. DKA was associated with significantly higher healthcare utilization and expenditures, driven primarily by inpatient and emergency care. Estimated total expenditures for type 1 diabetes or DKA-related encounters were approximately $13,950 per patient annually, with confirmed DKA cases incurring an additional $6,751 during the diagnosis window compared with potential DKA cases.
CONCLUSIONS: By leveraging multi-state APCDs, this study provides population-level estimates for incidence and healthcare expenditures. These findings highlight opportunities to improve early identification and inform strategies for type 1 diabetes screening.
METHODS: We conducted a retrospective cohort study using APCDs from Arkansas, Maryland, Oregon, and Utah in 2014-2022. Patients aged <18 years with newly identified type 1 diabetes were classified into three groups based on type 1 diabetes and DKA coding and encounter types: confirmed DKA, potential DKA, and outpatient-only diagnoses. Healthcare resource utilization and expenditures were assessed across baseline (-12 to -1 months), diagnosis (-1 to +3 months), and follow-up (+3 to +12 months) periods. Adjusted expenditures were estimated using two-part models - probit and generalized linear models with a gamma distribution and a log link. The study was funded by the Leona M. and Harry B. Helmsley Charitable Trust.
RESULTS: Among 14,120 patients with confirmed type 1 diabetes from APCDs, 2,078 (14.7%) patients had confirmed DKA and 1,545 (10.9%) patients had potential DKA. Substantial sociodemographic and geographic variations in DKA at diagnosis were observed. Patients with DKA were more likely to have Medicaid coverage and resided in areas with higher social vulnerability. DKA was associated with significantly higher healthcare utilization and expenditures, driven primarily by inpatient and emergency care. Estimated total expenditures for type 1 diabetes or DKA-related encounters were approximately $13,950 per patient annually, with confirmed DKA cases incurring an additional $6,751 during the diagnosis window compared with potential DKA cases.
CONCLUSIONS: By leveraging multi-state APCDs, this study provides population-level estimates for incidence and healthcare expenditures. These findings highlight opportunities to improve early identification and inform strategies for type 1 diabetes screening.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE480
Topic
Economic Evaluation, Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity)