Medical Costs of Diabetic Ketoacidosis Presenting at Diagnosis of Diabetes among Privately Insured Youth, 2016

Diabetes ketoacidosis (DKA) is a potentially preventable acute and severe complication of diabetes (DM). Youth often present with DKA at DM diagnosis and having DKA predicts poor long-term glycemic control. Little is known about the medical costs associated with DKA presenting at DM diagnosis. Using 2010-2016 MarketScan claims data, we estimated the occurrence of DKA at DM diagnosis and compared medical costs 60 days prior and post DM diagnosis in youth (age <20 years) with and without DKA. We identified newly diagnosed DM as having ≥1 inpatient or ≥2 outpatient claims 30 days apart with DM codes, but no DM claim or prescription of DM medications in the two years prior to DM diagnosis, no history of acute/chronic pancreatitis, and no gestational DM. Both DM and DKA were identified using ICD9 or ICD10 claim codes. We estimated medical costs (in U.S. $2016) using regression models (Table). Among 3,301 youth with newly diagnosed DM, 43% presented with DKA. As compared to youth without DKA, those with DKA were younger and more likely to be males (p<0.05). Health services use and total medical costs are presented in Table. The presence of DKA at DM diagnosis was associated with large financial burden to both the health care system (>$6,500) and to patients (>$1,100). These data could be used for planning and evaluating interventions aimed at preventing this life-threating condition.