1274-P: Impact of Type 1 Known Diabetes (T1D) Risk on Health-Care Utilization at Diagnosis

Despite increasing incidence of T1D worldwide, most newly-diagnosed individuals have no family history. Many experience delay in diagnosis, resulting in >30% of children with new-onset T1D presenting in diabetic ketoacidosis (DKA). Screening for T1D is currently restricted to the research setting. We sought to describe differences in health care utilization at T1D diagnosis in known at-risk patients identified through research studies compared to matched controls. Cases (n=39) were known islet autoantibody positive children (0-19 y) diagnosed with T1D between 2010-2017 at the Barbara Davis Center. Controls were matched 3:1 by dates of birth and diagnosis from community-diagnosed patients (n=117). The Colorado All Payer’s Claims Database was used to count diagnoses, procedures, and healthcare claims in the year before and following diagnosis. Continuous variables were compared using t-test or Wilcoxon rank sum test, categorical by chi-square. There was no difference between cases and controls for age of onset (9.6 +/- 3.6 vs. 9.6 +/- 3.5 y p=1.0) or gender (54 vs. 46% male, p=1.0); however, cases had higher rate of private insurance (72 vs. 49%, p=.01) and higher percentage of non-Hispanic whites (87 vs. 65%, p=.008). At diagnosis with T1D, cases had lower HbA1c (6.7 [6.1, 8.1]% vs. 12.1 [10.5, 14.1]%, p<.0001) and rate of DKA (5 vs. 57%, p<.0001). In the year prior to diagnosis, there were no differences in the number of claims, procedures, diagnoses, or medications. In contrast, in the year of diagnosis, cases had fewer emergency room claims (0 [0, 2] vs. 2 [0, 4], p<.0001), total claims (20 [9, 30] vs. 33 [19, 48], p<.0001), procedures (31 [16, 43] vs. 52 [28, 77] p<.0001) and unique diagnoses (7 [4, 10] vs. 12 [7, 19] p=.0003), while there was no difference in number of medications (8 [4, 10] vs10 [7, 13] p=.07).

In conclusion, antibody-screened patients had lower healthcare utilization in year of diagnosis. Further study, including cost estimation, may lend insight into benefits of T1D screening programs.