Understanding the Prevalence and Burden of Diabetic Ketoacidosis (DKA) in People with T1DM at High Risk for DKA: A Structured Literature Review
Author(s)
Varughese B1, Oliver L2, Bhaila R2, Rousseau B2
1Abbott Diabetes Care (Former), Dublin, CA, USA, 2Adelphi Values PROVE, Bollington, UK
Presentation Documents
OBJECTIVES:
Diabetic ketoacidosis (DKA) is a serious complication of diabetes, more common in T1DM than T2DM. Unmanaged DKA can be fatal and patients require emergency medical intervention. It is currently unclear how DKA impacts subpopulations of T1DM differently. This review investigated the burden and unmet need associated with DKA in pediatric/adolescent populations and in insulin-pump-users.METHODS:
Literature search via MEDLINE and Embase, using terms for unmet need and burden in T1DM, limited from 2011‑21, plus conference proceedings search from last two years. Publications were screened using pre-specified PICOS criteria.RESULTS:
424 articles met the inclusion criteria;145 reported on pediatrics/adolescents and insulin-pump-users. Preliminary results show a high incidence of DKA with rates of up to 55.5 per 1,000 patient-years in T1DM patients overall, and 108 per 1,000 patient-years in pediatrics/adolescents. Readmission rate for DKA at six months was reported as 13.2% in pediatric patients; with high prevalence of DKA (up to 32%) in insulin-pump-users, often due to device malfunction. DKA was associated with higher HbA1c; mean values for DKA patients were 12.3±1.8% versus 10.9±2.5% with no DKA at diagnosis. Severity of DKA was associated with duration of hospital stay (No DKA: 12 days; Mild-moderate DKA: 13 days; severe DKA: 14 days, p<0.001); 22.4% of DKA-related hospitalizations were at diagnosis, with 20.4% admitted to intensive care and a readmission rate of 16.6%. Risk of DKA recurrence was higher in patients with a DKA episode in the previous year compared to those without (OR 9.0 95% CI 7.6-10.8). No literature reviews of this overall topic were identified.CONCLUSIONS:
This was the first comprehensive review exploring the burden of DKA in pediatrics/adolescents and insulin-pump-users. These sub-populations were identified as high-risk for DKA, despite heterogeneity and inconsistency in reporting across studies. Further investigation into optimizing monitoring to reduce DKA is required.Conference/Value in Health Info
2022-11, ISPOR Europe 2022, Vienna, Austria
Value in Health, Volume 25, Issue 12S (December 2022)
Code
EPH138
Topic
Epidemiology & Public Health, Study Approaches
Topic Subcategory
Literature Review & Synthesis
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)